{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T12:10:09Z","timestamp":1763727009328,"version":"3.40.2"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Occipital artery\u2013posterior inferior cerebellar artery (OA-PICA) bypass is a technically challenging procedure for posterior fossa revascularization. The caudal loop of the PICA is considered the optimal site for OA-PICA anastomosis, however its absence can increase the technical difficulty associated with this procedure. The use of the far-lateral approach for accessing alternative anastomosis sites in OA-PICA bypass in patients with absent or unavailable caudal loops of PICA is evaluated.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A morphometric analysis of OA-PICA bypass with anastomosis on each segment of the PICA was performed on 5 cadaveric specimens through the conventional midline foramen magnum and far-lateral approaches. The difficulty level associated with anastomoses at each segment was qualitatively assessed in each approach for exposure and maneuverability by multiple surgeons. A series of 8 patients who underwent OA-PICA bypass for hemodynamic ischemia or ruptured dissecting posterior fossa aneurysms are additionally reviewed and described, and the clinical significance of the caudal loop of PICA is discussed.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Anastomosis on the caudal loop could be performed more superficially than on any other segment (p &lt; 0.001). A far-lateral approach up to the medial border of the posterior condylar canal provided a 13.5 \u00b1 2.2\u2013mm wider corridor than the conventional midline foramen magnum approach, facilitating access to alternative anastomosis sites. The far-lateral approach was successfully used for OA-PICA bypass in 3 clinical cases whose caudal loops were absent, whereas the midline foramen magnum approach provided sufficient exposure for caudal loop bypass in the remaining 5 cases.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The absence of the caudal loop of the PICA is a major contributing factor to the technical difficulty of OA-PICA bypass. The far-lateral approach is a useful surgical option for OA-PICA bypass when the caudal loop of the PICA is unavailable.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.11.jns151385","type":"journal-article","created":{"date-parts":[[2016,4,1]],"date-time":"2016-04-01T14:08:55Z","timestamp":1459519735000},"page":"634-644","source":"Crossref","is-referenced-by-count":11,"title":["The role of alternative anastomosis sites in occipital artery\u2013posterior inferior cerebellar artery bypass in the absence of the caudal loop using the far-lateral approach"],"prefix":"10.3171","volume":"126","author":[{"given":"Hitoshi","family":"Fukuda","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander I.","family":"Evins","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medical College, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Himeji Medical Center, Himeji, Hyogo, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Itaro","family":"Hattori","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Himeji Medical Center, Himeji, Hyogo, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichi","family":"Murao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Shiroyama Hospital, Habikino, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshitaka","family":"Kurosaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip E.","family":"Stieg","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medical College, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sen","family":"Yamagata","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Bernardo","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medical College, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns151385","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"e797","DOI":"10.1016\/j.wneu.2014.05.031","article-title":"Three-dimensional endoscope-assisted surgical approach to the foramen magnum and craniovertebral junction: minimizing bone resection with the aid of the endoscope","volume":"82","author":"Anichini G,","year":"2014","unstructured":"Anichini G, Evins AI, Boeris D, Stieg PE, Bernardo A: Three-dimensional endoscope-assisted surgical approach to the foramen magnum and craniovertebral junction: minimizing bone resection with the aid of the endoscope. 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