![]() ![]() PICA-PICA anastomosis is a useful procedure for reconstruction of the PICA when parent vessel occlusion or trapping is necessary to exclude a VA aneurysm involving the origin of the PICA. The remaining four cases experienced no new neurologic deficits. One patient experienced myopathy of the lower extremities secondary to intraoperative fixed board compression and developed permanent lower extremity muscular weakness. The remaining patient experienced hemorrhage from contralateral VA dissection and subsequently died. Postoperative cerebral angiography demonstrated patency of the anastomosis and regression of the aneurysm in five of six patients. After passing CN V, SCA enters the cerebellomesencephalic fissure, where its branches supply the superior cerebellar peduncle and are finally distributed to the tentorial cerebellar surface (Fig. It dips caudally and encircles the brainstem near the pontomesencephalic sulcus. The VA was subsequently occluded by clipping proximal and distal to the aneurysm, and the PICA was occluded by clipping distal to the aneurysm. SCA originates from the basilar artery (BA) near its apex. We present six patients with dissecting VA aneurysms who underwent PICA-PICA anastomosis combined with parent artery occlusion.Īfter a lower lateral suboccipital craniectomy and partial resection of the jugular tubercle, anastomoses were performed in a side-to-side fashion at the posterior medullary segment of the PICA. External carotid artery ligation only complicates the treatment of patients with cervicofacial AVMs, and should no longer be used in the treatment of these individuals.In patients with aneurysms that involve the origin of the posterior inferior cerebellar artery (PICA) and require occlusion of the vertebral artery (VA), revascularization of the PICA is commonly performed. The surgery must be carefully coordinated with the interventional radiologist for possible emergency postoperative embolization therapy. In one patient with severe epistaxis, external carotid artery revascularization led to the healing of the nasal ulcers without need for embolization therapy.įor patients with previous ligations of the external carotid artery and symptomatic AVMs, revascularization of the external carotid artery is an important step in treatment. In all, four patients underwent successful embolization therapy. Saphenous vein was used in five reconstructions a polytetrafluoroethylene graft was used in one.Īfter successful arterial reconstruction, massive swelling of the tongue and perioral tissue developed in two patients, which necessitated tracheostomy in one patient and embolization therapy before extubation could be safely performed in the other patient. Six patients with symptoms from cervicofacial arteriovenous malformations required surgical reconstruction of their previously ligated external carotid artery with the anticipation of catheter embolization therapy to the branch vessels feeding the malformation. The purpose of this report is to describe our experience with the treatment of patients with symptomatic unresectable cervicofacial AVMs and previous external carotid artery ligation. Previous ligation of the main feeding vessels prevents catheter access and embolization therapy of the lesion. Percutaneous transcatheter embolization of the nidus of the arteriovenous malformation is now the preferred treatment for symptomatic AVMs that cannot be excised. Rapid enlargement of collateral vessels around the ligature is usually associated with an early return of symptoms. Until recently, the accepted management of life-threatening complications of unresectable cervicofacial arteriovenous malformations (AVMs) has been ligation of the major feeding vessels, usually the branches or the main trunk of the external carotid artery. ![]()
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