Department of Surgery, Division of Neurosurgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Department of Surgery, Division of Neurosurgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
World Neurosurg. 2020 Jun;138:e539-e550. doi: 10.1016/j.wneu.2020.02.174. Epub 2020 Mar 7.
Unclippable vertebral artery aneurysms (UVAs) are difficult to treat with direct clipping, especially in cases involving the origin of the posterior inferior cerebellar artery (PICA). Bypass with trapping is the common procedure used for these conditions. The authors used the blind-alley formation technique, which is a simpler method than trapping and can avoid some complications.
To report 7 cases of UVA with PICA involvement treated with blind-alley formation and occipital artery (OA)-PICA bypass as well as their surgical outcomes and complications and to describe the operative techniques.
Seven patients with UVA and PICA involvement underwent OA-PICA bypass and blind-alley formation (occlusions of the PICA origin and vertebral artery proximal to the aneurysm). Vertebral artery dissecting aneurysms and fusiform atherosclerotic vertebral artery aneurysms were detected in 6 patients and 1 patient, respectively. All patients presented with subarachnoid hemorrhage, and 71.4% of them were classified into the poor-grade group. Good bypass patency and complete aneurysm obliteration were achieved in all cases. Six aneurysms (85.7%) were completely obliterated according to computed tomography angiography performed immediately postoperatively. Another aneurysm was 50% and 100% thrombosed immediately and at 7 days after the operation, respectively. Surgical complications were found in 1 patient (14.3%) who had postoperative diparesis with dysphagia. Three patients (42.9%) achieved a Glasgow Outcome Score of 4 or 5 one month after the operation.
Blind-alley formation and OA-PICA bypass are simple, safe, and effective for the treatment of patients with UVA with PICA involvement.
未夹闭的椎动脉动脉瘤（UVAs）很难通过直接夹闭进行治疗，尤其是在涉及后下小脑动脉（PICA）起源的情况下。对于这些情况，常用的手术方法是搭桥加阻断。作者使用了盲巷形成技术，这是一种比阻断更简单的方法，可以避免一些并发症。
报告 7 例 PICA 受累的 UVA 患者采用盲巷形成和枕动脉（OA）-PICA 旁路搭桥治疗，并描述其手术结果和并发症，以及手术技术。
7 例 PICA 受累的 UVA 患者接受了 OA-PICA 旁路搭桥和盲巷形成（PICA 起源和椎动脉动脉瘤近端闭塞）治疗。6 例患者为椎动脉夹层动脉瘤，1 例为梭形动脉粥样硬化性椎动脉动脉瘤。所有患者均表现为蛛网膜下腔出血，71.4%的患者为差分组。所有病例均实现了良好的旁路通畅和完全的动脉瘤闭塞。6 个动脉瘤（85.7%）根据术后即刻行 CT 血管造影显示完全闭塞。另一个动脉瘤分别在术后即刻和第 7 天血栓形成 50%和 100%。1 例患者（14.3%）术后出现偏瘫伴吞咽困难，发生手术并发症。3 例患者（42.9%）术后 1 个月格拉斯哥预后评分达到 4 或 5 分。
盲巷形成和 OA-PICA 旁路搭桥是治疗 PICA 受累的 UVA 患者的简单、安全、有效的方法。
