Abstract
Background:The unavailability of the superficial temporal artery (STA) and the location of lesions pose a more technically demanding challenge when compared with conventional STA-superior cerebellar or posterior cerebral artery (PCA) bypass in vascular reconstruction procedures. To describe a case series of patients with cerebrovascular lesions who were treated using an occipital artery (OA) to PCA bypass via the occipital interhemispheric approach.Methods:We retrospectively reviewed three consecutive cases of patients with cerebrovascular lesions who were treated using OA-PCA bypass.Results:OA-PCA bypass was performed via the occipital interhemispheric approach. This procedure included: (1) OA-PCA bypass (n = 1), and combined OA-posterior inferior cerebellar artery and OA-PCA saphenous vein interposition graft bypass (n = 1) in patients with vertebrobasilar ischemia; (2) OA-PCA radial artery interposition graft bypass in one patient with residual PCA aneurysm.Conclusions:OA-PCA bypass represents a useful alternative to conventional STA-SCA or PCA bypass.
Highlights
The unavailability of the superficial temporal artery (STA) and the location of lesions pose a more technically demanding challenge when compared with conventional STA‐superior cerebellar or posterior cerebral artery (PCA) bypass in vascular reconstruction procedures
Superficial temporal artery (STA)‐middle cerebral artery (MCA), STA‐superior cerebellar artery (SCA), STA‐posterior cerebral artery (PCA), and occipital artery (OA)-posterior inferior cerebellar artery (PICA) bypasses represent the mainstays for cerebral revascularization for supra‐ and infratentorial cerebral ischemia and aneurysms.[2,3,9,11,13,15]
An incompetent donor artery and inability to access the recipient artery poses challenges during revascularization procedures.[1]. This is true for patients who have undergone previous craniotomy in which the STA is diminutive or in which aneurysm and/or scar tissue overlie the recipient artery
Summary
We retrospectively reviewed three consecutive cases of patients with cerebrovascular lesions who were treated using OA‐PCA bypass. The patient was placed in a semiquarter prone position (park bench position). To harvest radial artery (RA), a forearm ipsilateral to the craniotomy was placed on the armrest. A skin incision was made along the OA with its limb extended along the midline to create a horseshoe shape [Figure 1a]. In Case 1, the ipsilateral OA was hypertrophied, and sufficient length (10 cm) of the arterial pedicle was dissected from the scalp. In Case 2, a left retromastoid C‐shaped skin incision was made to connect with the occipital horseshoe‐shaped incision on the right side [Figure 2a]. A relatively large craniotomy is preferable because it reduces the brain
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