Bypass revascularization applied to the posterior cerebral artery

• Published in: World neurosurgery 2016-12, Vol.96, p.460-472
• Main Authors: Ota, Nakao, M.D, Goehre, Felix, M.D., Ph.D, Miyazaki, Takanori, M.D, Kinoshita, Yu, M.D, Matsukawa, Hidetoshi, M.D, Yanagisawa, Takeshi, M.D, Sakakibara, Humihiro, M.D, Saito, Norihiro, M.D, Miyata, Shiro, M.D., Ph.D, Noda, Kosumo, M.D, Tsuboi, Toshiyuki, M.D., Ph.D, Kamiyama, Hiroyasu, M.D, Tokuda, Sadahisa, M.D, Kamada, Kyousuke, M.D., Ph.D, Tanikawa, Rokuya, M.D
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aneurysm; Anterior temporal approach; Bypass; Cerebral Revascularization - methods; Combined transpetrosal approach; Female; Humans; Intracranial Aneurysm - surgery; Male; Middle Aged; Neurosurgery; Posterior cerebral artery; Posterior Cerebral Artery - surgery; Posterior interhemispheric approach; Retrospective Studies; Treatment Outcome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.09.031

Abstract Background The application of bypass procedures to the posterior cerebral artery (PCA) in combination with proximal clipping or trapping is a useful option for the treatment of complex posterior circulation aneurysms, especially those of the PCA. Due to its course around the midbrain through various cisterns, different approaches are required to access the PCA. Objective The presented study analyzes a retrospective case series of bypass procedures to the PCA to investigate the relevant treatment strategies and their outcomes. Methods Seven patients with bypass procedures to the PCA bypass were analyzed. The location of the aneurysms, approaches, site of anastomosis, bypass patency, pre- and postoperative modified Rankin Scale (mRS) scores, and transient and permanent morbidity were assessed. Results Analyzed patients were treated for intracranial aneurysm located on the P2 (n=3), P3 (n=1) or P4 segment (n=1) of the PCA, bilateral vertebral artery dissecting aneurysm (n=1) or internal carotid artery - posterior communicating artery aneurysm (n=1). The following approaches were used: anterior temporal approach (ATA, n=2), ATA combined with subtemporal approach (n=2), combined trans-petrosal approach (n=1), posterior interhemispheric approach (PIHA, n=1) and PIHA with subtemporal approach (n=1). All bypasses were patent. Permanent morbidity occurred in two patients by cognitive dysfunction (n=1) and hemiparesis (n=1). Conclusions Bypass revascularization of the PCA territory is effective for the treatment of complex vascular lesions affecting the posterior circulation. To address the various surgical segments of the PCA, different approaches are required. Combined approaches allow access to the PCA proximal and distal from the lesion.