Subject(s)
Cervical Vertebrae , Intervertebral Disc Displacement/complications , Lumbar Vertebrae , Radiculopathy/drug therapy , Steroids/administration & dosage , Animals , Contraindications , Humans , Injections, Epidural/adverse effects , Radiculopathy/etiology , Sciatica/drug therapy , Sciatica/etiology , Spondylolisthesis/complicationsABSTRACT
Eighty-three patients underwent 85 intracranial to extracranial pedicle bypass anastomosis procedures to the posterior circulation. There were 15 patients with occipital artery (OA) to posterior inferior cerebellar artery (PICA) anastomosis, 20 patients with OA to anterior inferior cerebellar artery (AICA) anastomosis, and 50 patients with superficial temporal artery (STA) to superior cerebellar artery (SCA) anastomosis. All patients had transient ischemic attacks (TIA's) suggestive of vertebrobasilar ischemia. Twenty-seven patients had crescendo TIA's or stroke in evolution and were considered to be clinically unstable. All patients had severe bilateral distal vertebral artery or basilar artery disease. Twenty-two patients had bilateral vertebral artery occlusion and three had basilar artery occlusion. In this series, 69% had complete resolution of symptoms; the mortality rate was 8.4% and the morbidity rate 13.3%. Clinically stable patients did better than unstable patients. The STA-SCA anastomosis was well tolerated and technically less demanding than the OA-PICA or OA-AICA anastomosis procedures. Patients with symptomatic severe bilateral vertebral or basilar artery disease have a grave prognosis and the option of a surgical arterial pedicle revascularization procedure should be offered to them.
Subject(s)
Cerebral Arteries/surgery , Cerebral Revascularization/methods , Vertebrobasilar Insufficiency/surgery , Adult , Aged , Anastomosis, Surgical , Cerebellum/blood supply , Cerebral Angiography , Female , Humans , Male , Middle Aged , Occipital Lobe/blood supply , Temporal Arteries , Vertebrobasilar Insufficiency/diagnostic imagingABSTRACT
A unique example of posterior fossa revascularization is presented. A tandem bypass was performed by anastomosing the midoccipital artery to the posterior inferior cerebellar artery in a side-to-side fashion followed by anastomosis of the distal occipital artery to the anterior inferior cerebellar artery in an end-to-side fashion. The operation was designed to revascularize two separate vascular territories that were isolated in a patient thought to have an extremely compromised posterior circulation. The patient is doing well and is asymptomatic 3 years postoperatively.
