Acta Neurochirurgica

, Volume 155, Issue 11, pp 2121–2125 | Cite as

How I Do it: side to side posterior inferior cerebellar artery –posterior inferior cerebellar artery bypass procedure

  • Amir R. DehdashtiEmail author
How I Do it - Vascular



An intracranial in situ side to side posterior circulation procedure is performed infrequently. The scope of treatment modalities of vertebral artery-PICA aneurysms and vertebral dissections is limited due to the lack of many representations of this procedure’s technical nuances.


To demonstrate the technical nuances of a PICA-PICA side to side bypass in a 50-year-old woman with a dissecting vertebral-PICA junction pseudoaneurysm.


Details of the pre-operative evaluation, decision process and operative nuances of side to side PICA-PICA bypass are described. Indications and limitations are emphasized. Vascular neurosurgeons should consider this elegant procedure in their treatment armamentarium.


PICA Revascularization Side to side Posterior fossa Bypass 


Conflicts of interest


Supplementary material


(MOV 185265 kb)


  1. 1.
    Crowley RW, Medel R, Dumont AS (2009) Operative nuances of an occipital artery to posterior inferior cerebellar artery bypass. Neurosurg Focus 26(5):E19PubMedCrossRefGoogle Scholar
  2. 2.
    Evans JJ, Sekhar LN, Rak R, Stimac D (2004) Bypass grafting and revascularization in the management of posterior circulation aneurysms. Neurosurgery 55(5):1036–1149PubMedCrossRefGoogle Scholar
  3. 3.
    Kawashima M, Rhoton AL Jr, Tanriover N, Ulm AJ, Yasuda A, Fujii K (2005) Microsurgical anatomy of cerebral revascularization. Part II: posterior circulation. J Neurosurg 102(1):132–147PubMedCrossRefGoogle Scholar
  4. 4.
    Korja M, Sen C, Langer D (2010) Operative nuances of side-to-side in situ posterior inferior cerebellar artery-posterior inferior cerebellar artery bypass procedure. Neurosurgery 67(2 suppl operative):471–477PubMedGoogle Scholar
  5. 5.
    Lemole GM Jr, Henn J, Javedan S, Deshmukh V, Spetzler RF (2002) Cerebral revascularization performed using posterior inferior cerebellar artery-posterior inferior cerebellar artery bypass. Report of four cases and literature review. J Neurosurg 97(1):219–223PubMedCrossRefGoogle Scholar
  6. 6.
    Lewis SB, Chang DJ, Peace DA, Lafrentz PJ, Day AL (2002) Distal posterior inferior cerebellar artery aneurysms: clinical features and management. J Neurosurg 97(4):756–766PubMedCrossRefGoogle Scholar
  7. 7.
    Nussbaum ES, Madison MT, Myers ME, Goddard J, Janjua T (2008) Dissecting aneurysms of the posterior inferior cerebellar artery: retrospective evaluation of management and extended follow-up review in 6 patients. J Neurosurg 109(1):23–27PubMedCrossRefGoogle Scholar
  8. 8.
    Quinones-Hinojosa A, Lawton MT (2005) In situ bypass in the management of complex intracranial aneurysms: technique application in 13 patients. Neurosurgery 57(1 suppl):140–145, 29PubMedCrossRefGoogle Scholar
  9. 9.
    Sekhar LN, Natarajan SK, Ellenbogen RG, Ghodke B (2008) Cerebral revascularization for ischemia, aneurysms, and cranial base tumors. Neurosurgery 62(6 suppl 3):1373–1408, discussion 408–10PubMedGoogle Scholar
  10. 10.
    Spetzler RF, Zabramski J (1982) Revascularization of anterior and posterior circulation ischemia. Clin Neurosurg 29:575–593PubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  1. 1.Department of Neurosurgery, Cushing Neuroscience InstituteNorthshore University HospitalManhassetUSA

Personalised recommendations