{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T12:51:20Z","timestamp":1655815880339},"reference-count":21,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background:<\/jats:title>\n<jats:p>Giant thrombosed vertebral artery aneurysms (GTVAs) are difficult disease to treat. Here, we are reporting a case of GTVA successfully treated with excluding the pathological segment and restoring the anterograde blood flow of the parent artery, highlighting the reliable surgical procedure.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Case Description:<\/jats:title>\n<jats:p>A 55-year-old man with a left GTVA complained of right hemiparesis (manual muscle testing 4\/5) represented by hand clumsiness and gait disturbance, in addition to severe left-sided dysesthesia, was referred to our hospital. The posterior inferior cerebellar artery (PICA) was incorporated into the GTVA segment, and the contralateral vertebral artery showed atherosclerotic change. Thus, we decided to treat the aneurysm with aneurysm trapping and thrombectomy, in conjunction with V3-radial artery graft (RAG)-V4 bypass and occipital artery (OA)-PICA bypass through a suboccipital transcondylar approach. The distal end of the dilated segment was meandering and deflecting outwardly to the vicinity of the internal auditory canal and was stretched in an axial direction. Thus, the V4 stump can be transposed to the triangle space made by the medulla, lower cranial nerves, and sigmoid sinus, and we could perform a safe and reliable anastomosis through the corridor. After the surgery, the compression of the brain stem was released, and right hemiparesis was improved completely after rehabilitation. The patient was discharged with a modified Rankin Scale score of 1.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Conclusion:<\/jats:title>\n<jats:p>Trapping of the aneurysm and thrombectomy are the most radical treatment for GTVA, and if possible, reconstruction of anterograde blood flow with V3-RAG-V4 bypass and OA-PICA bypass is desirable.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_385_2019","type":"journal-article","created":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T08:31:33Z","timestamp":1573806693000},"page":"220","update-policy":"http:\/\/dx.doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Surgical removal using V3-radial artery graft-V4 bypass and occipital artery-posterior inferior cerebellar artery bypass for a giant thrombosed aneurysm of vertebral artery compressing brain stem: Case report"],"prefix":"10.25259","volume":"10","author":[{"given":"Sho","family":"Tsunoda","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomohiro","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuaki","family":"Naemura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsuya","family":"Akabane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2019,11,15]]},"reference":[{"key":"10.25259\/SNI_385_2019\/ref-1","first-page":"1514","article-title":"Endovascular treatment of intracranial vertebral artery dissections with stent placement or stent-assisted coiling","volume":"27","author":"Ahn","year":"2006","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_385_2019\/ref-2","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1097\/00006123-199905000-00101","article-title":"Recanalization and rupture of a giant vertebral artery aneurysm after hunterian ligation: Case report","volume":"44","author":"Chang","year":"1999","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_385_2019\/ref-3","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s00062-015-0494-8","article-title":"Long-term outcome of tubridge flow diverter(S) in treating large vertebral artery dissecting aneurysms a pilot study","volume":"27","author":"Fang","year":"2017","journal-title":"Clin Neuroradiol"},{"key":"10.25259\/SNI_385_2019\/ref-4","doi-asserted-by":"crossref","first-page":"418","DOI":"10.3171\/2008.3.17470","article-title":"Application of covered stent grafts for intracranial vertebral artery dissecting aneurysms","volume":"110","author":"He","year":"2009","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_385_2019\/ref-5","doi-asserted-by":"crossref","first-page":"407","DOI":"10.3171\/jns.2003.98.2.0407","article-title":"Continued growth of and increased symptoms from a thrombosed giant aneurysm of the vertebral artery after complete endovascular occlusion and trapping: The role of vasa vasorum. 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