Akitsugu Kawashima1, Hugo Andrade-Barazarte2, Behnam Rezai Jahromi2, Minna Oinas2, Ahmed Elsharkawy3, Juri Kivelev2, Yuichi Kubota4, Takakazu Kawamata5, Juha A Hernesniemi2. 1. Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan. 2. Depart-ment of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 3. Department of Neu-rosurgery, Tanta University, Tanta, Egypt. 4. Department of Neurosurgery, Asakadai Central Hospital, Saitama, Japan. 5. Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Abstract
BACKGROUND: Posterior cerebral artery (PCA) aneurysms are rare and the majority are fusiform in shape. Proximal occlusion of PCA represents a treatment option for these lesions. However, this procedure carries a high risk of ischemic complications. OBJECTIVE: To describe the technique of trapping a fusiform PCA aneurysm and revascularization of the distal PCA using a superficial temporal artery (STA) graft through the same microsurgical approach. METHODS: From September 2012 to October 2014, we retrospectively identified 3 patients harboring a fusiform PCA aneurysm (P2 segment aneurysm) who underwent trapping of the aneurysm and reconstruction of the distal PCA through the same subtemporal approach. We analyzed immediate morbidity, surgical complications, and the patency of the bypass to determine the feasibility of this procedure. RESULTS: All 3 patients underwent successful trapping of the fusiform PCA aneurysm and revascularization of the distal PCA. The origin of P3 segment or posterior temporal artery (PTA) served as recipient arteries. In all 3 cases, adequate blood flow was evident after performing the STA-P3/PTA bypass. None of the patients experienced a new permanent neurological deficit. At 1-year follow-up, the STA-PTA/PCA bypasses remained patent. CONCLUSION: The STA-P3/PTA bypass through the subtemporal approach is a feasible option to maintain blood flow in cases of PCA fusiform aneurysms requiring trapping of the P2 segment.
BACKGROUND: Posterior cerebral artery (PCA) aneurysms are rare and the majority are fusiform in shape. Proximal occlusion of PCA represents a treatment option for these lesions. However, this procedure carries a high risk of ischemic complications. OBJECTIVE: To describe the technique of trapping a fusiform PCA aneurysm and revascularization of the distal PCA using a superficial temporal artery (STA) graft through the same microsurgical approach. METHODS: From September 2012 to October 2014, we retrospectively identified 3 patients harboring a fusiform PCA aneurysm (P2 segment aneurysm) who underwent trapping of the aneurysm and reconstruction of the distal PCA through the same subtemporal approach. We analyzed immediate morbidity, surgical complications, and the patency of the bypass to determine the feasibility of this procedure. RESULTS: All 3 patients underwent successful trapping of the fusiform PCA aneurysm and revascularization of the distal PCA. The origin of P3 segment or posterior temporal artery (PTA) served as recipient arteries. In all 3 cases, adequate blood flow was evident after performing the STA-P3/PTA bypass. None of the patients experienced a new permanent neurological deficit. At 1-year follow-up, the STA-PTA/PCA bypasses remained patent. CONCLUSION: The STA-P3/PTA bypass through the subtemporal approach is a feasible option to maintain blood flow in cases of PCA fusiform aneurysms requiring trapping of the P2 segment.
Authors: Alex R Flores; Visish M Srinivasan; Jill Seeley; Charity Huggins; Peter Kan; Jan-Karl Burkhardt Journal: World Neurosurg Date: 2020-08-20 Impact factor: 2.104