PMC8185168_01
Preoperative and postoperative DSA comparison. (A-C): Preoperative DSA (A, A-P view; B, lateral view) showing an aneurysm (black arrow) located at main trunk of the right AICA; (D-F): Preoperative DSA (D, A-P view; E, lateral view) showing the aneurysm disappeared and the distal AICA patency.
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F1
The distal AICA supplied a wide range of blood, and the ipsilateral posterior inferior cerebellar artery was absent as shown in Figures 1A-C. Cerebrovascular angiography before discharge indicated that the aneurysm disappeared, the distal and proximal ends of the AICA had patency, and the blood supply range was the same as before operation (Figures 1D-F).
Schematic diagram of operation. Right AICA aneurysm located in a2 segments, intracranial artery anastomosis in situ was perform after trapping and resection. (cAICA, caudal trunk of AICA; mAICA, main trunk of AICA; rAICA, rostral trunk of AICA; a2, lateral pontine segments of AICA).
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F2
After dissociating the proximal and distal vessels of the AICA, end-to-end intracranial vascular anastomosis of a2 AICA-a2 AICA was performed in situ (the schematic diagram of the operation is shown in Figure 2), and intraoperative fluorescence angiography was performed to confirm the patency of the anastomotic vessels (Figures 3B,C).
Intraoperative image. (A): Aneurysm neck and parent artery were not clearly defined. (B,C): a2AICA-a2AICA anastomosis in situ after aneurysm resection, intraoperative fluorescence imaging confirmed patency.
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F3
The aneurysm was closely adhered to the surrounding arachnoid with a wide neck and unclear boundary between the neck and the parent artery (Figure 3A). After dissociating the proximal and distal vessels of the AICA, end-to-end intracranial vascular anastomosis of a2 AICA-a2 AICA was performed in situ (the schematic diagram of the operation is shown in Figure 2), and intraoperative fluorescence angiography was performed to confirm the patency of the anastomotic vessels (Figures 3B,C).