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

• Published in: World neurosurgery Vol. 127; pp. e768 - e778
• Main Authors: De Vilalta, Alex, Kournoutas, Ioannis, Ojeda, Pablo López, Canals, Andreu Gabarrós, Vigo, Vera, Rutledge, Caleb W., Chae, Ricky, Abla, Adib A., Rubio, Roberto Rodriguez
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2019
• Subjects: Anterior inferior cerebellar artery; Cadaver; Cerebellum - blood supply; Cerebellum - pathology; Cerebellum - surgery; Cerebral Revascularization - methods; End-to-side; Humans; Intracranial Aneurysm - pathology; Intracranial Aneurysm - surgery; Occipital artery; Posterior inferior cerebellar artery; Revascularization; Side-to-side; Vertebral Artery - pathology; Vertebral Artery - surgery; EC-IC; Side-to-side; CN; CN VII; IC-IC; Posterior inferior cerebellar artery; OA; PICA; LA; End-to-side; AICA; CPF; Occipital artery; Anterior inferior cerebellar artery; CN VI; CMF; Revascularization; BA
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2019.03.260

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. 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. 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. 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). 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.