• Hisashi Kubota, Rokuya Tanikawa, Makoto Katsuno, Naoto Izumi, Kosumo Noda, Nakao Ota, Yohei Ishishita, Takanori Miyazaki, Shinichi Okabe, Sumio Endo, Mika Niemelä, and Masaaki Hashimoto.
• Far East Neurosurgical Institute Abashiri Neurological Hospital, Hokkaido, Japan.
• World Neurosurg. 2014 Jan 1;81(1):202.e1-8.

BackgroundThe treatment of unclippable vertebral artery (VA) aneurysms incorporating the posterior inferior cerebellar artery with parent artery preservation is among one of the most formidable challenges for cerebrovascular microsurgery and endovascular surgery. We propose that intracranial VA reconstruction using an extracranial VA-to-intracranial VA (VA-VA) bypass with a radial artery graft or an occipital artery graft may be an additional technique in the armamentarium to treat these formidable lesions. The rationale, surgical technique, and complications are discussed.MethodsThree illustrative cases are described, in which the lesions were a VA dissecting aneurysm with ischemic lesions, bilateral asymptomatic unruptured VA aneurysms, and a VA giant aneurysm with subarachnoid hemorrhage.ResultsThe partial extreme lateral infrajugular transcondylar approach was used. Computed tomographic angiography was useful for preoperative evaluation of the depth of the distal aneurysmal neck. A VA-VA bypass was performed in two patients. Because there was another ipsilateral aneurysm at the V2 segment in one patient, an external carotid artery-VA bypass was performed. Although two patients were discharged with good clinical results, one patient with subarachnoid hemorrhage died because of brainstem infarction.ConclusionsThe VA-VA bypass using a radial artery graft or an occipital artery graft is an option that can be considered in the strategy for treating VA aneurysms to preserve the normal anatomic vascular configuration in the posterior circulation.Copyright © 2014 Elsevier Inc. All rights reserved.

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