J Korean Neurosurg Soc.  2014 Jan;55(1):36-39. 10.3340/jkns.2014.55.1.36.

A Case of Endovascular Treatment for Followed by Side to Side Bypass for Vertebral Artery Dissecting Aneurysms Involved Posterior Inferior Cerebellar Artery

• Chung SY
• Yoon BH
• Park MS
• Kim SM

• KMID: 2191038
• DOI: http://doi.org/10.3340/jkns.2014.55.1.36

Abstract

Treatment of complex aneurysms usually entails not only direct clipping but also alternative treatment modality. We recently experienced a case of vertebral artery dissecting aneurysm and obtained good treatment outcomes. Our case suggests that the endovascular segmental occlusion with posterior inferior cerebellar artery (PICA) to PICA side anastomosis might be a good treatment option in patients with complex vertebral artery dissecting aneurysms. A 45-year-old woman has a left vertebral dissecting aneurysm with dizziness. Based on the aneurysmal morphology and the involvement of PICA, the patient underwent side to side anastomosis of the PICA. This was followed by the endovascular segmental coil occlusion. The aneurysmal sac was completely obliterated. At a 2-year follow-up, the patient achieved a good patency of both PICA. In conclusion our case suggests that the endovascular segmental occlusion of the parent artery followed by PICA to PICA bypass surgery through a midline suboccipital approach is a reasonable multimodal treatment option in patients with complex vertebral artery dissecting aneurysms.

Keyword

PICA dissecting aneurysm; Segmental occlusion; Multimodal treatment; Complex aneurysm

MeSH Terms

Aneurysm
Aneurysm, Dissecting*
Arteries*
Combined Modality Therapy
Dizziness
Female
Follow-Up Studies
Humans
Middle Aged
Parents
Pica
Vertebral Artery*

Figure

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  Fig. 1 Three dimensional computed tomography angiography shows left vertebral artery mild stenosis on admission day and magnetic resonance angiography shows no interval change of left vertebral artery stenosis on 5th hospital days.

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  Fig. 2 On day 10, complex vertebral dissecting aneurysm of long segment includs posterior inferior cerebellar artery origin by transfemoral cerebral angiography (AP, Lateral, Oblique view).

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  Fig. 3 Tonsilomedullary and telovelotonsilar segments of the right posterior inferior cerebellar artery (PICA) shows parallel course compared with contralateral same segments of PICA.

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  Fig. 4 Posterior inferior cerebellar artery (PICA) to PICA side anastomosis was done and the patency looks well by intraoperative indocyanine green angiography.

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  Fig. 5 Post-revascularization transfemoral cerebral angiography after posterior inferior cerebellar artery (PICA) to PICA anastomosis shows the good patency of both PICA from right vertebral artery (VA) and still shows Lt. VA-PICA dissecting aneurysm.

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  Fig. 6 Post endovascular segmental occlusion using coil with stent shows total occlusion of vertebral artery dissecting aneurysm and both posterior inferior cerebellar artery was patent.

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