Revascularization of the posterior inferior cerebellar artery using the occipital artery: A cadaveric study comparing the p3 and p1 recipient sites

Document Type

Article

Abstract

BACKGROUND: Revascularization of the posterior inferior cerebellar artery (PICA) is typically performedwith the occipital artery (OA) as an extracranial donor. The p3 segment is the most accessible recipient site for OA-PICA bypass at its caudal loop inferior to the cerebellar tonsil, but this site may be absent or hidden due to a high-riding location. OBJECTIVE: To test our hypothesis that freeing p1 PICA from its origin, transposing the recipient into a shallower position, and performing OA-p1 PICA bypass with an end-to-end anastomosis would facilitate this bypass. METHODS: The OA was harvested, and a far lateral craniotomy was performed in 16 cadaveric specimens. PICA caliber and number of perforators were measured at p1 and p3 segments. OA-p3 PICA end-to-side and OA-p1 PICA end-to-end bypasses were compared. RESULTS: OA-p1 PICA bypass with end-to-end anastomosis was performed in 16 specimens; whereas, OA-p3 PICA bypass with end-to-side anastomosis was performed in 11. Mean distance from OA at the occipital groove to the anastomosis site was shorter for p1 than p3 segments (30.2 vs 48.5 mm; P < .001). Median number of perforators on p1 was 1, and on p3, itwas 4 (P < .001). CONCLUSION: Although most OA-PICA bypasses can be performed using the p3 segment as the recipient site for an end-to-side anastomosis, a more feasible alternative to conventionalOA- p3 PICA bypass in cases of high-riding caudal loops or aberrant anatomy is to free the p1 PICA, transpose it away from the lower cranial nerves, and perform an end-to-end OA-p1 PICA bypass instead.

Publication Date

8-1-2020

Publication Title

Operative Neurosurgery

ISSN

23324252

E-ISSN

23324260

Volume

19

Issue

2

First Page

E122

Last Page

E129

PubMed ID

32107553

Digital Object Identifier (DOI)

10.1093/ons/opaa023

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