Bypass and vascular reconstruction for posterior circulation aneurysms

Abstract

Posterior circulation aneurysms are among the most challenging problems facing the cerebrovascular neurosurgeon. Aneurysms of the vertebrobasilar system maybe broad necked or fusiform and may involve critical branches, such as the cerebellar vessels, brain stem perforators, or the posterior cerebral arteries (PCAs). Furthermore, optimal exposure of these lesions often requires specialized expertise in cranialbase anatomy and microvascular surgery. Parent vessel or perforator occlusion may result in a devastating stroke or death. Direct surgical repair, Hunterian ligation or trapping, and endovascular stenting or coiling are the treatment options that may not always be feasible [ 1 ]. These challenges and the poor natural history of symptomatic posterior fossa aneurysms havefueled interest in continuing the development of posterior circulation revascularization technique to improve the management of these diffi cult cases.