1
|
Rinaldo L, Abla AA. Trapping and side-to-end superior cerebellar artery to superior cerebellar artery bypass for treatment of fusiform superior cerebellar artery aneurysm. J Clin Neurosci 2023; 118:12-15. [PMID: 37832265 DOI: 10.1016/j.jocn.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023]
Abstract
We describe the technical nuances of in-situ bypass for treatment of a fusiform superior cerebellar artery (SCA) aneurysm via surgical trapping and a side-to-end in-situ bypass between duplicated SCAs. Our patient is a 40-year-old male who presented with an incidental aneurysm of the proximal right superior cerebellar artery (SCA). Formal angiography was performed that demonstrated a fusiform morphology of the aneurysm, as well as a duplicated SCA on that side. After extensive counseling, the patient elected to undergo surgical clip reconstruction with possible bypass. A large frontotemporal craniotomy was performed and a combined transsylvian-subtemporal approach to the ventral anterolateral brainstem was performed. After identifying the aneurysm, the tentorium was incised posterior to the insertion of the trochlear nerve to widen the operative field. An end-to-side anastomosis between the duplicated SCAs was performed, followed by trapping of the diseased arterial segment. The patient had an oculomotor nerve palsy post-operatively, however this resolved by his six-month follow-up. In-situ bypass is a viable technique for revascularizing the SCA territory during clip reconstruction of fusiform aneurysms. A duplicated SCA allows for an SCA to SCA bypass. Incising the tentorium can increase visualization of donor and recipient vessels and facilitate performance of the anastomosis.
Collapse
Affiliation(s)
- Lorenzo Rinaldo
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Adib A Abla
- Department of Neurologic Surgery, University of Miami School of Medicine, Miami, FL, USA.
| |
Collapse
|
2
|
Sunohara Y, Sakamoto Y, Maeda K, Takemoto M, Choo J, Ikezawa M, Fujita O, Sago F, Somiya D, Ikeda A. A case of a brain stem infarction caused by basilar artery occlusion treated with superficial temporal Artery-Superior cerebellar artery bypass surgery. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
3
|
Uda K, Tanahashi K, Mamiya T, Kanamori F, Yokoyama K, Nishihori M, Izumi T, Araki Y, Saito R. Advantages of petrosectomy for superficial temporal artery to superior cerebellar artery bypass based on three-dimensional distance measurements using cadaver heads. Neurosurg Rev 2021; 45:1617-1624. [PMID: 34735687 PMCID: PMC8976806 DOI: 10.1007/s10143-021-01686-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/28/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022]
Abstract
Superficial temporal artery (STA) to superior cerebellar artery (SCA) bypass is usually performed via the subtemporal approach (StA), anterior transpetrosal approach (ApA), or combined petrosal approach (CpA), but no study has yet reported a quantitative comparison of the operative field size provided by each approach, and the optimal approach is unclear. The objective of this study is to establish evidence for selecting the approach by using cadaver heads to measure the three-dimensional distances that represent the operative field size for STA-SCA bypass. Ten sides of 10 cadaver heads were used to perform the four approaches: StA, ApA with and without zygomatic arch osteotomy (ApA-ZO- and ApA-ZO+), and CpA. For each approach, the major-axis length and the minor-axis length at the anastomosis site (La-A and Li-A), the major-axis length and the minor-axis length at the brain surface (La-B and Li-B), the depth from the brain surface to the anastomosis site (Dp), and the operating angles of the major axis and the minor axis (OAa and OAi) were measured. Shallower Dp and wider operating angle were obtained in the order CpA, ApA-ZO+, ApA-ZO-, and StA. In all parameters, ApA-ZO- extended the operative field more than StA. ApA-ZO+ extended La-B and OAa more than ApA-ZO-, whereas it did not contribute to Dp and OAi. CpA significantly decreased Dp, and widened OAa and OAi more than ApA-ZO+. ApA and CpA greatly expanded the operative field compared with StA. These results provide criteria for selecting the optimal approach for STA-SCA bypass in light of an individual surgeon's anastomosis skill level.
Collapse
Affiliation(s)
- Kenji Uda
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan.
| | - Kuniaki Tanahashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Takashi Mamiya
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Fumiaki Kanamori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8550, Japan
| |
Collapse
|