• Hisashi Kubota, Rokuya Tanikawa, Makoto Katsuno, Kosumo Noda, Nakao Ota, Shiro Miyata, Tomonari Yabuuchi, Naoto Izumi, Ketan R Bulsara, and Masaaki Hashimoto.
• Abashiri Neurolosurgical-Rehabilitation Hospital, 4-1-7 Katsuramachi, Abashiri, Hokkaido 093-0041, Japan. kubopo@gmail.com
• Acta Neurochir (Wien). 2013 Aug 1;155(8):1517-24; discussion 1524.

BackgroundSymptomatic fusiform intracranial vertebral artery aneurysms pose a formidable treatment challenge when not amenable to endovascular treatment. In this paper, we illustrate the microsurgical management of such an aneurysm.MethodsTo prevent neurological deterioration, anatomical reconstruction preserving all vessels including posterior inferior cerebellar artery and perforators is essential. In this case illustration, the occipital artery was used as a donor to a perforator originating from the aneurysmal segment. This bypass was performed in an end-to-side fashion. Subsequently, the aneurysmal component of the vertebral artery was resected and an end-to-side (V4 to V3) bypass was performed using a radial artery graft.ResultsThe patient achieved complete resection of the aneurysm preserving normal anatomy of the posterior circulation without any ischemic complications.ConclusionsComplex cerebral artery bypass techniques are essential in the armamentarium of cerebrovascular for the treatment of complex lesions not amenable to endovascular therapy.

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