gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Vertebral artery-to-posterior inferior cerebellar artery bypass with radial artery graft for hemorrhagic dissecting vertebral artery aneurysms – surgical technique and report of two cases

Meeting Abstract

  • Marcus Czabanka - Department of Neurosurgery, Charité Universitätsmedizin Berlin, Germany
  • Muhammad Ali - Department of Neurosurgery, University of California, San Francisco, CA , USA
  • Peter Schmiedek - Department of Neurosurgery, University Hospital Mannheim, Germany
  • Peter Vajkoczy - Department of Neurosurgery, Charité Universitätsmedizin Berlin, Germany
  • Michael T. Lawton - Department of Neurosurgery, University of California, San Francisco, CA , USA

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1830

DOI: 10.3205/10dgnc301, URN: urn:nbn:de:0183-10dgnc3013

Published: September 16, 2010

© 2010 Czabanka et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Endovascular occlusion of hemorrhagic dissecting aneurysms of the vertebral artery (VA) is not possible when the posterior inferior cerebellar artery (PICA) originates from the dissecting aneurysm or the contralateral VA provides inadequate collateral blood flow to the distal basilar circulation. We introduce the VA-PICA bypass with a radial artery interposition graft and aneurysm trapping as an alternative approach, and describe two cases where this bypass was used to treat hemorrhagic dissecting VA aneurysms.

Methods: The VA-PICA bypass is performed through a standard far lateral approach. An end-to-side anastomosis between the radial artery graft and PICA at the level of the caudal loop is performed first and an end-to-side anastomosis is performed between V3 segment and the proximal end of the radial artery graft.

Results: A 56 year-old woman had a hemorrhagic dissecting VA aneurysm incorporated the origin of the PICA. Enodovascular treatment failed with aneurysm refilling during follow-up angiography. A 65 year-old man had a hemorrhagic dissecting VA aneurysm and a hypoplastic contralateral VA. Both patients were treated with VA-PICA bypass and aneurysm trapping, with adequate filling of the PICA territory in the first patient and both the PICA territory and basilar circulation in the second patient.

Conclusions: VA-PICA bypass with radial artery interposition graft and subsequent trapping of the dissected VA segment is an alternative to occipital artery-to-PICA and PICA-PICA bypass for the treatment of hemorrhagic dissecting VA aneurysms that are not suitable for endovascular occlusion.