Occipital Artery-Posterior Inferior Cerebellar Artery Bypass for the Treatment of Aneurysm of Vertebral Artery and Posterior Inferior Cerebellar Artery
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Abstract
Objective: To describe and evaluate the surgical techniques of occipital artery- posterior inferior Cerebellar artery (OA-PICA) bypass for treatment of patients with vertebral artery and posterior inferior cerebellar artery (PICA) aneurysms using “L” shape skin incision and multiple-layer dissection of suboccipital muscle techniques.
Methods: This was a retrospective descriptive study in patients with vertebral artery and PICA aneurysms who received OA-PICA bypass at Faculty of Medicine Vajira Hospital between June 2015 and September 2018. Morphology of aneurysm, location, definite treatment, bypass patency rate, complete obliteration rate of aneurysm, surgical complication and outcomes were collected from medical records. The surgical techniques and 3 illustrative cases were also described.
Results: Nine patients with vertebral artery and PICA aneurysms received OA-PICA bypass. Vertebral artery dissecting aneurysm, fusiform artherosclerotic vertebral artery aneurysm and proximal PICA aneurysm were detected in 7, 1 and 1 patient respectively. All patients presented with subarachnoid hemorrhage and 77.8% of them were classified into poor-grade group. For definite treatment of the aneurysm, proximal occlusion, trapping and aneurysm neck clipping were performed in 7 patients, 1 and 1 patient respectively. One hundred percent was achieved for bypass patency rate and complete obliteration of the aneurysms. Surgical complication rate was found in 2 patients (22.2%), one patient had postoperative diparesis with dysphagia and one had surgical wound infection. One patient died from severe sepsis after operation. Five patients (55.6%) achieved Glasgow Outcome Score (GOS) of 4, 5 at 1 month after operation.
Conclusion: The presented techniques of OA-PICA bypass were safe and provided precise OA-PICA anastomoses which resulted in high patency rate of bypass graft.
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References
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