PMC4533424_01
Preoperative 3-dimensional computed tomography angiogram. A: Bilateral fusiform aneurysms of vertebral artery are seen. B: Vertebrobasilar artery system, from posterior, demonstrates deviation to the right. C: Oblique view demonstrates the right posterior inferior cerebellar artery is arising from the aneurysm.
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F1
The whole vertebrobasilar artery was deviated to the right (Fig. 1A-C).
A: Upper shema demonstrating the entire relationship to the lower cranial nerves. B: Lower shema demonstrating our procedure, V3-radial artery graft-V4 bypass with proximal clipping of the vertebral artery to spare perforating artery arising at the just distal point of the aneurysm and occipital artery-posterior inferior cerebellar artery (PICA) bypass with proximal clipping of PICA.
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F2
The patient had no symptoms and was treated not with a trapping but a proximal clipping of the VA to prevent perforator ischemia (Fig. 2).
Postoperative 3-dimensional computed tomography angiogram. A: The right aneurysm is eliminated. The right vertebral artery is remade by radial artery graft successfully. B: The occipital artery-posterior inferior cerebellar artery bypass is seen. C: Oblique view.
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F3
The postoperative 3DCTA revealed the right VA remade by the RAG and the elimination of the right VA aneurysm (Fig. 3A-C).