Indo Masahiro, Oya Soichi, Nakamura Sho, Kobayashi Ikuo, Yoshida Shinsuke, Shojima Masaaki, Nemoto Shigeru
Department of Neurosurgery, Higashi Yamato Hospital, Higashi Yamato, Tokyo, Japan.
Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
J Neurosurg Case Lessons. 2025 Jan 20;9(3). doi: 10.3171/CASE24527.
The presence of significant tortuosity in access routes to aneurysms can interfere with catheter guidance and manipulation and significantly impact treatment strategies.
In this report, the authors combined intentional staged aneurysm embolization with the construction of a new direct access route, which they call a "highway bypass," for a symptomatic posterior circulation cerebral aneurysm that was difficult to access with a catheter. Notably, the highway bypass is used for catheter passage, and technical tips should be considered. The patient had a symptomatic unruptured cerebral aneurysm in the first segment of the left posterior cerebral artery with bilateral internal carotid artery occlusion and severe tortuosity of the bilateral vertebral arteries. The highway bypass using a radial artery graft was performed in the first stage; in the second stage, the aneurysm was accessed using the graft, and embolization was performed. The catheter was passed through the graft without complications. The aneurysm was successfully embolized, no ischemic lesions were found in the postoperative images, and the patient was discharged without worsening neurological findings.
Intentional staged aneurysm embolization combined with the highway bypass effectively treats aneurysms that are difficult to access. Anastomoses should be designed to allow catheters to pass through the graft. https://thejns.org/doi/10.3171/CASE24527.
通向动脉瘤的入路存在明显迂曲会干扰导管的引导和操作，并对治疗策略产生重大影响。
在本报告中，作者将有创分期动脉瘤栓塞与构建一种新的直接入路相结合，他们将其称为“高速公路旁路”，用于治疗经导管难以到达的有症状的后循环脑动脉瘤。值得注意的是，“高速公路旁路”用于导管通过，应考虑技术要点。该患者在左侧大脑后动脉第一段有一个有症状的未破裂脑动脉瘤，双侧颈内动脉闭塞，双侧椎动脉严重迂曲。第一阶段采用桡动脉移植进行“高速公路旁路”手术；第二阶段，通过移植血管到达动脉瘤并进行栓塞。导管顺利通过移植血管，未出现并发症。动脉瘤成功栓塞，术后影像未发现缺血性病变，患者出院时神经功能未恶化。
有创分期动脉瘤栓塞联合“高速公路旁路”可有效治疗难以到达的动脉瘤。吻合口的设计应允许导管通过移植血管。https://thejns.org/doi/10.3171/CASE24527
