• Alex De Vilalta, Ioannis Kournoutas, Pablo López Ojeda, Canals Andreu Gabarrós AG Department of Neurosurgery, Hospital Universitari de Bellvitge, Barcelona, Spain., Vera Vigo, Caleb W Rutledge, Ricky Chae, Adib A Abla, and Roberto Rodriguez Rubio.
• Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Neurosurgery, Hospital Universitari de Bellvitge, Barcelona, Spain.
• World Neurosurg. 2019 Jul 1; 127: e768-e778.

IntroductionAnterior inferior cerebellar artery (AICA) aneurysms are rare, accounting for 0.2%-1.3% of all intracranial aneurysms. The standard treatment is often endovascular embolization or neck clipping; however, sacrifice of the parent vessel is sometimes necessary. Addition of revascularization procedures is a subject of controversy. The occipital artery (OA) has been used as a donor for bypass, but recently there has been a trend toward intracranial-intracranial approaches. The posterior inferior cerebellar artery (PICA)-AICA side-to-side bypass may serve as a safe alternative.ObjectiveTo characterize the PICA-AICA side-to-side bypass and the OA-AICA end-to-side bypass and review the literature relevant to AICA revascularization.MethodsWe performed a far-lateral approach on 12 cadaveric specimens and analyzed the regional anatomy. On this basis, we performed either an OA-AICA or a PICA-AICA bypass and took morphometric measurements relevant to the technique.ResultsPICA-AICA bypass was successful in 6/12 specimens. The length of the flocculopeduncular segment was 42.6 ± 15.8 mm in the specimens in which the bypass was feasible and 26.2 ± 7.2 mm in those in which the bypass was not feasible (P = 0.04). Mean distance between AICA and PICA was 5.3 ± 4 mm in the specimens in which side-to-side bypass was feasible and 11.6 ± 4.2 mm in the specimens in which it was not (P = 0.02). OA-AICA end-to-side bypass was feasible in all the specimens (75% in the flocculopeduncular segment; 25% in the cortical segment).ConclusionsThis is the first cadaveric study analyzing the PICA-AICA side-to-side bypass for AICA revascularization. Our analyses provide evidence for the feasibility of this bypass and document the anatomic variations that may indicate its use.Copyright © 2019 Elsevier Inc. All rights reserved.

20 keywords...

hide…