Department of Neurosurgery, Antwerp University Hospital (UZA), Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
Department of Neurosurgery, Lille University Hospital, Hopital Nord, Lille, France.
World Neurosurg. 2021 Aug;152:214-220. doi: 10.1016/j.wneu.2021.05.029. Epub 2021 May 21.
OBJECTIVE/BACKGROUND: The need for revascularization of the distal posterior cerebral artery (PCA) in the treatment of PCA aneurysms is a contentious issue. Approaches to the PCA, such as the subtemporal route, carry significant perioperative risk. This risk at times outweighs the risk of ischemia associated with endovascular PCA sacrifice. This paper describes the use of an extreme lateral supracerebellar infratentorial (ELSCIT) approach as an alternative technique for distal PCA revascularization.
Between 2016 and 2019, 3 patients underwent a PCA bypass via the ELSCIT approach for the treatment of a PCA aneurysm. In all cases, an end-to-side anastomosis to the P2- or P3-segment of the PCA was made, with the occipital artery as a donor. Bypass procedures were followed by endovascular parent artery occlusion, without ischemic complications.
In all 3 cases, the ELSCIT approach offered a broad enough surgical corridor to perform an occipital artery-to-PCA bypass. One patient suffered a cerebrospinal fluid leak that was surgically treated. Patients' clinical conditions were stable on follow-up (mean follow-up of 34 months). All 3 aneurysms remained occluded, and no ischemia was detected on magnetic resonance imaging.
The ELSCIT approach offers an alternative route to the distal PCA for extracranial-to-intracranial bypass with seemingly low perioperative morbidity and good surgical access to the PCA.
目的/背景：在后循环动脉瘤治疗中，远端大脑后动脉（PCA）血运重建的需求是一个有争议的问题。到达 PCA 的方法，如颞下入路，存在显著的围手术期风险。有时这种风险超过了血管内 PCA 牺牲相关的缺血风险。本文描述了一种极端外侧小脑幕下小脑上（ELSCIT）入路，作为远端 PCA 血运重建的替代技术。
在 2016 年至 2019 年期间，3 例患者因 PCA 动脉瘤而行 PCA 旁路术，采用 ELSCIT 入路。在所有病例中，均行 PCA 的 P2 或 P3 段端侧吻合，以枕动脉为供体。旁路手术后行血管内母动脉闭塞，无缺血并发症。
在所有 3 例患者中，ELSCIT 入路提供了足够宽的手术通道，可进行枕动脉至 PCA 旁路术。1 例患者发生脑脊液漏，经手术治疗。患者的临床状况在随访时稳定（平均随访 34 个月）。所有 3 个动脉瘤均保持闭塞，磁共振成像未发现缺血。
ELSCIT 入路为颅外至颅内旁路提供了一种替代远端 PCA 的途径，围手术期并发症发生率低，对 PCA 的手术入路良好。
