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

Alex De Vilalta; Ioannis Kournoutas; Pablo López Ojeda; Andreu Gabarrós Canals; Vera Vigo; Caleb W Rutledge; Ricky Chae; Adib A Abla; Roberto Rodriguez Rubio

doi:10.1016/j.wneu.2019.03.260

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

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

Authors

Alex De Vilalta¹, Ioannis Kournoutas², Pablo López Ojeda³, Andreu Gabarrós Canals³, Vera Vigo², Caleb W Rutledge⁴, Ricky Chae², Adib A Abla⁵, Roberto Rodriguez Rubio⁶

Affiliations

¹ Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Neurosurgery, Hospital Universitari de Bellvitge, Barcelona, Spain.
² Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
³ Department of Neurosurgery, Hospital Universitari de Bellvitge, Barcelona, Spain.
⁴ Department of Neurological Surgery, University of California, San Francisco, California, USA.
⁵ Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
⁶ Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA. Electronic address: luis.rodriguezrubio@ucsf.edu.

PMID: 30951912
DOI: 10.1016/j.wneu.2019.03.260

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.

MeSH terms

Cadaver
Cerebellum / blood supply*
Cerebellum / pathology
Cerebellum / surgery*
Cerebral Revascularization / methods*
Humans
Intracranial Aneurysm / pathology
Intracranial Aneurysm / surgery*
Vertebral Artery / pathology
Vertebral Artery / surgery