{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:55:04Z","timestamp":1786125304174,"version":"build-2736575974"},"reference-count":8,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T00:00:00Z","timestamp":1624579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    A 71-yr-old woman was discovered to have an incidental distal basilar artery (BA) fusiform aneurysm 7 \u00d7 5 mm in dimension, shaped like an \u201cumbrella handle\u201d with critical stenosis distal to the aneurysm. The right posterior cerebral artery (PCA) P1 segment was small; the left posterior communicating artery (PComA) was miniscule. Because the natural history of fusiform BA aneurysms is poorly defined, this was equated to a saccular aneurysm, with an estimated 10-yr rupture rate of 29%.\n                    <jats:sup>1-8<\/jats:sup>\n                    After discussion of alternative treatments, the patient decided upon surgery. Because of inadequate collateral circulation, a bypass to the left PCA was deemed necessary.\n                  <\/jats:p>\n                  <jats:p>\u2003The aneurysm was exposed by an extended trans-sylvian approach, and the left PCA P2 segment was visualized subtemporally. The left radial artery (RAG) was extracted, and pressure distended to prevent vasospasm. The RAG bypass was sutured first to the P2, and then to the cervical external carotid artery (ECA); the BA aneurysm was then clipped. The proximal anastomosis of the bypass needed revision because of poor flow; a 4-mm punch hole was made to widen the arteriotomy on the ECA. The patient was discharged home with mild memory loss and partial left cranial nerve III palsy. After discharge, she developed a severe left hemicrania, resolved with gabapentin. At 6-wk follow-up, she was asymptomatic, and computed tomography (CT) angiogram demonstrated patency of the bypass.<\/jats:p>\n                  <jats:p>\u2003The patient gave informed consent for surgery and video recording. All relevant patient identifiers have been removed from the video and accompanying radiology slides.<\/jats:p>","DOI":"10.1093\/ons\/opab192","type":"journal-article","created":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T17:43:08Z","timestamp":1624642988000},"page":"E250-E251","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Distal Basilar Artery \u201cUmbrella Aneurysm\u201d Treated by Radial Artery Graft Bypass From the External Carotid Artery to Posterior Cerebral Artery and Clip Trapping: 2-Dimensional Operative Video"],"prefix":"10.1227","volume":"21","author":[{"given":"Varadaraya S","family":"Shenoy","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Lavergne","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeeshan","family":"Qazi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basavaraj V","family":"Ghodke","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington, USA"},{"name":"Department of Radiology, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9105-2874","authenticated-orcid":false,"given":"Laligam N","family":"Sekhar","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,9]]},"reference":[{"issue":"24","key":"bib1-20250822","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1056\/NEJM199812103392401","article-title":"Unruptured intracranial aneurysms\u2014risk of rupture and risks of surgical intervention","volume":"339","year":"1998","journal-title":"N Engl J Med"},{"issue":"9378","key":"bib2-20250822","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/S0140-6736(03)13860-3","article-title":"Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment","volume":"362","year":"2003","journal-title":"Lancet"},{"issue":"8","key":"bib3-20250822","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1136\/neurintsurg-2014-011281","article-title":"Posterior circulation flow diversion: a single-center experience and literature review","volume":"7","author":"Toth","year":"2015","journal-title":"J NeuroIntervent Surg"},{"issue":"1","key":"bib4-20250822","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1227\/NEU.0000000000001175","article-title":"Bypass surgery for the treatment of dolichoectatic basilar trunk aneurysms: a work in progress","volume":"79","author":"Lawton","year":"2016","journal-title":"Neurosurgery"},{"issue":"6","key":"bib5-20250822","doi-asserted-by":"crossref","first-page":"E14","DOI":"10.3171\/2017.3.FOCUS1748","article-title":"Endovascular management of fusiform aneurysms in the posterior circulation: the era of flow diversion","volume":"42","author":"Awad","year":"2017","journal-title":"Neurosurg Focus"},{"issue":"4","key":"bib6-20250822","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1161\/STROKEAHA.114.006909","article-title":"Natural history and management of basilar trunk artery aneurysms","volume":"46","author":"Saliou","year":"2015","journal-title":"Stroke"},{"issue":"5","key":"bib7-20250822","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1136\/neurintsurg-2017-013312","article-title":"Meta-analysis of treatment outcomes of posterior circulation non-saccular aneurysms by flow diverters","volume":"10","author":"Kiyofuji","year":"2018","journal-title":"J Neurointerv Surg"},{"issue":"4","key":"bib8-20250822","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s00234-016-1649-2","article-title":"Flow diverter treatment of posterior circulation aneurysms. A meta-analysis","volume":"58","author":"Wang","year":"2016","journal-title":"Neuroradiology"}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/article-pdf\/21\/3\/E250\/39655768\/opab192.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab192","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:53:26Z","timestamp":1786121606000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab192"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,25]]},"references-count":8,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opab192","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,25]]},"assertion":[{"value":"2020-12-16","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-04","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}