![]() ![]() However, the OA-PICA bypass has been reported to cause a few complications. ![]() The occipital artery (OA)-PICA bypass is a typical vascular reconstruction surgery for aneurysms in this area. 1 ) Many cases of PICA aneurysms are nonsaccular or fusiform aneurysms in which a simple clipping technique cannot be applied, and trapping surgery with vascular reconstruction is often required. Posterior inferior cerebellar artery (PICA) aneurysms are rare and account for only 3%-4% of all brain aneurysms. For some patients with systemic disorders, the PICA-PICA bypass could be an optimal treatment option for proximal fusiform PICA aneurysms rather than as an alternative to the OA-PICA bypass. In comparison with the OA-PICA bypass, the PICA-PICA bypass is less likely to cause CSF leakage and skin complications, although it carries the risk of specific ischemic complications and requires advanced surgical techniques. The postoperative course was uneventful, and the patient was discharged on day 64 without any neurological disorders. We performed the PICA-PICA bypass and trapping surgery rather than the OA-PICA bypass to avoid skin problems and CSF leakage. The patient had many systemic disorders such as microscopic polyangiitis and steroid-induced diabetes mellitus that could have caused wound dehiscence and cerebrospinal fluid (CSF) leakage. Radiological examination revealed a right proximal PICA fusiform aneurysm. A 79-year-old man presented with a chief complaint of sudden, severe headache and disturbances in consciousness. In this article, we report a case of proximal PICA ruptured aneurysm that was treated with a PICA-to-PICA (PICA-PICA) bypass. Although a few cases of intracranial-to-intracranial bypass have been reported, this type of vascular reconstruction is only regarded as an alternative to the OA-PICA bypass because of the uncertainty of bypass feasibility and potential risk of ischemic complications. Despite its potential complications, the occipital artery-to-posterior inferior cerebellar artery (OA-PICA) bypass is a typical treatment because of its versatility. All rights reserved.Posterior inferior cerebellar artery (PICA) aneurysms often require cerebral vascular reconstruction for surgical treatment because of their characteristic morphology. OA–PICA bypass PICA communicating artery Posterior inferior cerebellar artery subarachnoid hemorrhage.Ĭopyright © 2014 National Stroke Association. If the aneurysm has a shape that is difficult to clip, the affected vessel is difficult to preserve, and collateral blood flow to the affected PICA region is considered insufficient, trapping with OA-PICA bypass is recommended. Ours is the first case in which a ruptured aneurysm of this vessel was treated surgically with concurrent vascular reconstruction. Six cases of aneurysms occurring in this vessel including ours have been reported, and hemodynamic factors and congenital fragility of the arterial wall have been suggested as causative factors. Trapping was performed for the 2 aneurysms with occipital artery (OA)-PICA bypass. Aneurysms arose in the communicating artery, and a small, unruptured fusiform aneurysm was observed adjacent to a ruptured aneurysm. Cerebral angiography showed a defect of the left PICA, and the left PICA region was supplied by a communicating artery formed by the fusion of branches from the right PICA and right vertebral artery. A 47-year-old man presented with a rare aneurysm arising from the posterior inferior cerebellar artery communicating artery (PICA com A), manifesting as subarachnoid with intraventricular hemorrhage. ![]()
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