Hellow guys, Welcome to Utubetrends, and you are watching Far-lateral Craniotomy for PICA-PICA Bypass and Trapping of PICA Aneurysm. and this vIdeo is uploaded by Barrow Neurological Institute at 2020-06-04T18:06:47-07:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | Far-lateral Craniotomy for PICA-PICA Bypass and Trapping of PICA Aneurysm |
| Video Uploader | Video From Barrow Neurological Institute |
| Upload Date | This Video Uploaded At 05-06-2020 01:06:47 |
| Video Discription | This operative video shows a far-lateral craniotomy for trapping of a posterior inferior cerebellar artery (PICA) with PICA-PICA bypass. The patient presented with an incidental right unruptured aneurysm on PICA. Neuroimaging confirmed the presence of a right dysplastic PICA aneurysm, which enlarged on serial imaging. Our surgical strategy consisted of a right far-lateral craniotomy and C1 laminectomy with left p3 PICA-right p3 PICA intracranial-intracranial in situ bypass followed by clipping of the complex right proximal PICA aneurysm. The key aspect of the approach was the aggressive removal of the occipital condyle, which involved drilling away all of the bone above the V3 segment of the vertebral artery and following the bone of the foramen magnum out as far as possible. The patient had a large occipital sinus that required the use of Weck clips to occlude the sinus from above and also from below to open dura. The caudal loop of the right PICA was identified in the cisterna magna and followed over the obex of the fourth ventricle, revealing the contralateral PICA. The arachnoid adhesions were carefully cut to liberate and approximate the donor and recipient arteries. The arteries were marked with violet ink, temporary clips were applied, and the arteriotomies were performed. An anchoring stitches were placed on the caudal and cranial ends of the arteriotomies. The anastomosis was completed using a running continuous suture on both the anterior and posterior segments of the arteriotomy. The temporary clips were removed and patency of the bypass was confirmed. Our attention then turned to the aneurysm, which was clipped with a straight Sugita clip. Indocyanine green (ICG) videoangiography revealed that clipping the apparent neck of the aneurysm also occluded the PICA. However, retrograde flow through the PICA-PICA bypass and up through the remaining perforators perfused the vascular territory. Postoperative imaging confirmed patency of the bypass and occlusion of the aneurysm. In conclusion, fusiform/dolichoectatic aneurysms are difficult to clip reconstruct. Nonsaccular morphology is seen with dissections and dolichoectatic aneurysms. PICA-PICA in situ bypass is an elegant alternative to OA-PICA bypass. In situ bypass has a lower morbidity than reimplantation. Endovascular aneurysm occlusion risks ischemic complications and secondary cerebellar swelling and brainstem compression. |
| Category | Science & Technology |
| Tags | c1 laminectomy | neurosurgery | cerebrovascular surgery | neurosurgery video | pica aneurysm | pica aneurysm clipping | pica-pica bypass | surgery of the craniovertebral junction |
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