Lang Michael J, Catapano Joshua S, Paisan Gabriella M, Koester Stefan W, Cole Tyler S, Labib Mohamed A, Zhou James J, Fredrickson Vance L, Frisoli Fabio A, Lawton Michael T
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Oper Neurosurg. 2020 Sep 1;19(3):E314-E319. doi: 10.1093/ons/opaa016.
Posterior inferior cerebellar artery (PICA) aneurysms are uncommon, and aneurysms associated with anatomical PICA variants are even rarer. Although often treated endovascularly, aneurysms associated with anatomical PICA variants may not be suitable for endovascular intervention because of the risk of compromise of brainstem perforators and may be more amenable to open techniques. This case report describes the successful treatment of an aneurysm associated with a double-origin PICA (DOPICA) by distally reimplanting one of the PICA limbs.
A 78-yr-old man with a Hunt-Hess grade III, Fisher grade IV subarachnoid hemorrhage secondary to a ruptured distal right PICA aneurysm associated with a DOPICA was treated with PICA-PICA bypass and trapping of the aneurysm. This is the first reported case in the literature of successful bypass of a DOPICA-associated aneurysm. Radiographically, the bypass remained patent with successful obliteration of the aneurysm, and at discharge from the hospital, the patient had a Glasgow Coma Scale score of 15 and modified Rankin Scale score of 3.
This case demonstrates a novel reimplantation bypass for a ruptured aneurysm that exploits this rare variant anatomy of a DOPICA.
小脑后下动脉（PICA）动脉瘤并不常见，与PICA解剖变异相关的动脉瘤则更为罕见。尽管这类动脉瘤常采用血管内治疗，但与PICA解剖变异相关的动脉瘤可能因存在脑干穿支血管受损的风险而不适合血管内干预，或许更适合采用开放手术技术。本病例报告描述了通过将PICA的一个分支向远端重新植入成功治疗与双起源PICA（DOPICA）相关的动脉瘤的过程。
一名78岁男性，因与DOPICA相关的右侧PICA远端动脉瘤破裂导致Hunt-Hess分级为III级、Fisher分级为IV级的蛛网膜下腔出血，接受了PICA-PICA搭桥及动脉瘤夹闭术。这是文献中首次报道成功绕过与DOPICA相关动脉瘤的病例。影像学检查显示，搭桥血管保持通畅，动脉瘤成功闭塞，出院时患者格拉斯哥昏迷量表评分为15分，改良Rankin量表评分为3分。
本病例展示了一种针对破裂动脉瘤的新型重新植入搭桥手术，该手术利用了DOPICA这种罕见的变异解剖结构。
