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. 2019 Jul:127:e768-e778.
doi: 10.1016/j.wneu.2019.03.260. Epub 2019 Apr 2.

Revascularization of the Anterior Inferior Cerebellar Artery Using Extracranial and Intracranial Donors: A Morphometric Cadaveric Study

Alex De Vilalta  1 , Ioannis Kournoutas  2 , Pablo López Ojeda  3 , Andreu Gabarrós Canals  3 , Vera Vigo  2 , Caleb W Rutledge  4 , Ricky Chae  2 , Adib A Abla  5 , Roberto Rodriguez Rubio  6
Affiliations

Revascularization of the Anterior Inferior Cerebellar Artery Using Extracranial and Intracranial Donors: A Morphometric Cadaveric Study

Alex De Vilalta et al. World Neurosurg. 2019 Jul.

Abstract

Introduction: Anterior inferior cerebellar artery (AICA) aneurysms are rare, accounting for 0.2%-1.3% of all intracranial aneurysms. The standard treatment is often endovascular embolization or neck clipping; however, sacrifice of the parent vessel is sometimes necessary. Addition of revascularization procedures is a subject of controversy. The occipital artery (OA) has been used as a donor for bypass, but recently there has been a trend toward intracranial-intracranial approaches. The posterior inferior cerebellar artery (PICA)-AICA side-to-side bypass may serve as a safe alternative.

Objective: To characterize the PICA-AICA side-to-side bypass and the OA-AICA end-to-side bypass and review the literature relevant to AICA revascularization.

Methods: We performed a far-lateral approach on 12 cadaveric specimens and analyzed the regional anatomy. On this basis, we performed either an OA-AICA or a PICA-AICA bypass and took morphometric measurements relevant to the technique.

Results: PICA-AICA bypass was successful in 6/12 specimens. The length of the flocculopeduncular segment was 42.6 ± 15.8 mm in the specimens in which the bypass was feasible and 26.2 ± 7.2 mm in those in which the bypass was not feasible (P = 0.04). Mean distance between AICA and PICA was 5.3 ± 4 mm in the specimens in which side-to-side bypass was feasible and 11.6 ± 4.2 mm in the specimens in which it was not (P = 0.02). OA-AICA end-to-side bypass was feasible in all the specimens (75% in the flocculopeduncular segment; 25% in the cortical segment).

Conclusions: This is the first cadaveric study analyzing the PICA-AICA side-to-side bypass for AICA revascularization. Our analyses provide evidence for the feasibility of this bypass and document the anatomic variations that may indicate its use.

Keywords: Anterior inferior cerebellar artery; End-to-side; Occipital artery; Posterior inferior cerebellar artery; Revascularization; Side-to-side.

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