OA to a3-AICA bypass is an alternative in cases where primary reanastomosis is not technically feasibleīambakidis et al. This technique has been reported in the literature for distally located aneurysms (a3-AICA).4 Microanastomosis for more medial AICA aneurysms must be performed deep to the lower cranial nerves. To our knowledge, this is the first report of AICA reanastomosis in the proximal a2-AICA (lateral pontine) segment. AICA reanastomosis is an elegant intracranial-intracranial bypass for treating distal AICA aneurysms. The patient made a complete recovery at late follow-up. Postoperatively, she developed epidural and subdural hematomas due to human immunodeficiency virus-associated coagulopathy and/or increased aspirin sensitivity, requiring reoperation. Indocyanine green videoangiography and postoperative angiogram confirmed bypass patency. After aneurysm excision, an a2-AICA-a2-AICA end-to-end reanastomosis was performed in between and deep to the vestibulocochlear nerves superiorly and the glossopharyngeal nerve inferiorly. An extended retrosigmoid approach exposed the infectious aneurysm. The occipital artery was harvested as an alternative donor in the myocutaneous flap using a hockey-stick incision. Neuroimaging revealed a fusiform left a2-AICA aneurysm, thought to be mycotic with diffuse subarachnoid and intraventricular hemorrhage (Hunt-Hess Grade-IV). A 51-yr-old woman with newly diagnosed acquired immunodeficiency syndrome presented to the hospital with meningitis and experienced an acute neurological decline while admitted. Their 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 regionĪ video reports a novel bypass for a ruptured, fusiform distal AICA aneurysm. AICA revascularization allows for the safe treatment of AICA aneurysms and other posterior circulation pathologies without compromising perfusion of the AICA territories.Īll 7 AICA bypasses are feasible for application to AICA aneurysms and ischemic disease.
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. Bypass types included extracranial-to-intracranial (EC-IC) bypass without an interpositional graft, EC-IC with an interpositional graft, in situ bypass, reanastomosis, reimplantation, intracranial-to-intracranial bypass with interpositional graft, and combination bypasses. They used 7 types of bypasses to revascularize the AICA territory.
#Aica vs pica syndrome series
described a series of AICA bypasses to treat 4 AICA aneurysms and 3 vertebral artery/AICA occlusions.
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