TY - JOUR
T1 - Anterior inferior cerebellar artery bypasses
T2 - The 7-bypass framework applied to ischemia and aneurysms in the cerebellopontine angle
AU - Baranoski, Jacob F.
AU - Przybylowski, Colin J.
AU - Mascitelli, Justin R.
AU - Lang, Michael J.
AU - Lawton, Michael T.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - BACKGROUND: Aneurysms of the anterior inferior cerebellar artery (AICA) are rare. Primary clip reconstruction of these lesions is a challenge because of the limited surgical exposure and frequent nonsaccular aneurysm morphology. Endovascular treatment options exist, but outcomes are equivalent to those for open surgery. Historically, AICA aneurysms not amenable to clipping or primary coiling have been treated with parent vessel sacrifice. OBJECTIVE: To determine whether an AICA revascularization strategy would afford for the safe treatment of AICA aneurysms and other posterior circulation pathologies without compromising perfusion of the AICA territories. METHODS: We describe a series of AICA bypasses to treat 4 AICA aneurysms and 3 vertebral artery/AICA occlusions. RESULTS: We used 7 types of bypasses to revascularize the AICA territory. Bypass types included extracranial-to-intracranial (EC-IC) bypass without an interpositional graft, EC-IC with an interpositional graft, in situ bypass, reanastomosis, reimplantation, intracranialto- intracranial bypass with interpositional graft, and combination bypasses. In particular, we performed the following 7 bypasses: OA-a3 AICA, OA-RAG-a3 AICA, p3 PICA-a3 AICA, a2 AICA reanastomosis, V4 VA-a3 AICA, V3 VA-SVG-a3 AICA, and a combined OA-a3 AICA bypass and p3 PICA reanastomosis. AICA revascularization allows for the safe treatment of AICA aneurysms and other posterior circulation pathologies without compromising perfusion of the AICA territories. CONCLUSION: All 7 AICA bypasses are feasible for application to AICA aneurysms and ischemic disease. Our experience with the 7-bypass framework demonstrates the utility of the framework as a decision-making tool and the breadth of bypass innovation possible in this anatomically challenging region.
AB - BACKGROUND: Aneurysms of the anterior inferior cerebellar artery (AICA) are rare. Primary clip reconstruction of these lesions is a challenge because of the limited surgical exposure and frequent nonsaccular aneurysm morphology. Endovascular treatment options exist, but outcomes are equivalent to those for open surgery. Historically, AICA aneurysms not amenable to clipping or primary coiling have been treated with parent vessel sacrifice. OBJECTIVE: To determine whether an AICA revascularization strategy would afford for the safe treatment of AICA aneurysms and other posterior circulation pathologies without compromising perfusion of the AICA territories. METHODS: We describe a series of AICA bypasses to treat 4 AICA aneurysms and 3 vertebral artery/AICA occlusions. RESULTS: We used 7 types of bypasses to revascularize the AICA territory. Bypass types included extracranial-to-intracranial (EC-IC) bypass without an interpositional graft, EC-IC with an interpositional graft, in situ bypass, reanastomosis, reimplantation, intracranialto- intracranial bypass with interpositional graft, and combination bypasses. In particular, we performed the following 7 bypasses: OA-a3 AICA, OA-RAG-a3 AICA, p3 PICA-a3 AICA, a2 AICA reanastomosis, V4 VA-a3 AICA, V3 VA-SVG-a3 AICA, and a combined OA-a3 AICA bypass and p3 PICA reanastomosis. AICA revascularization allows for the safe treatment of AICA aneurysms and other posterior circulation pathologies without compromising perfusion of the AICA territories. CONCLUSION: All 7 AICA bypasses are feasible for application to AICA aneurysms and ischemic disease. Our experience with the 7-bypass framework demonstrates the utility of the framework as a decision-making tool and the breadth of bypass innovation possible in this anatomically challenging region.
KW - Aneurysm
KW - Anterior inferior cerebellar artery (AICA)
KW - Bypass
KW - Extracranial-to-intracranial
KW - Interpositional
KW - Intracranial-to-intracranial
KW - Reanastomosis
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U2 - 10.1093/ons/opz347
DO - 10.1093/ons/opz347
M3 - Article
C2 - 31768556
AN - SCOPUS:85088178226
VL - 19
SP - 165
EP - 174
JO - Operative Neurosurgery
JF - Operative Neurosurgery
SN - 2332-4252
IS - 2
ER -