PMC4584442_01
(a) Axial diffusion-weighted magnetic resonance image of the brain reveals bilateral posterior cerebral artery territory ischemic change. (b) T2-weighted imaging demonstrates a sizeable right posterior inferior cerebellar artery infarction with early mass effect
SNI-6-148-g001.jpg
PMC4584442_01_SNI-6-148-g001.jpg
F1
A magnetic resonance imaging (MRI) examination of the brain revealed bilateral posterior cerebral artery (PCA) territory ischemic changes with a sizeable right posterior inferior cerebellar artery (PICA) infarction [Figure 1].
(a) Right internal carotid arteriogram demonstrates moderate spasm of the A1 (arrow) and more severe narrowing of the A2 (arrowhead) segments of the anterior cerebral artery. (b) Vertebral arteriographic image shows severe narrowing of the distal vertebral arteries (arrowheads) with thread-like appearance (arrow) of the basilar artery itself
SNI-6-148-g002.jpg
PMC4584442_01_SNI-6-148-g002.jpg
F2
An emergency angiogram demonstrated severe spasm of the posterior circulation with the basilar artery having an almost thread-like appearance and moderate vasospasm of the anterior circulation [Figure 2].
Intraoperative photomicrographic image demonstrating completed anastomosis of the occipital artery to a cortical branch of the posterior cerebral artery
SNI-6-148-g003.jpg
PMC4584442_01_SNI-6-148-g003.jpg
F3
At this point, the occipital artery (OA) was dissected, and a small occipital supratentorial parasagittal craniotomy was performed through which the OA was anastomosed to a cortical branch of the PCA with 11-0 interrupted suture [Figure 3].
(a) Late angiographic follow-up imaging demonstrates significant improvement in the caliber of the basilar artery. (b and c) Delayed arteriographic images showing the occipital artery (arrowhead) filling the posterior cerebral artery (arrow)
SNI-6-148-g004.jpg
PMC4584442_01_SNI-6-148-g004.jpg
F4
Repeated angiographic examinations demonstrated slow improvement in the degree of arterial narrowing and filling of the posterior cerebral territory through the bypass [Figure 4].
Delayed, magnetic resonance image, obtained 6 months after presentation shows dramatic normalization of the previously visualized ischemic changes corresponding to the patients' ultimately favorable outcome
SNI-6-148-g005.jpg
PMC4584442_01_SNI-6-148-g005.jpg
F5
Six months later, the patient had made a striking recovery with only limited visual field impairment and was back to work on a near full-time basis [Figure 5].