{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T18:44:40Z","timestamp":1792262680554,"version":"4.4.0"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECT<\/jats:title>\n                    <jats:p>Intracranial-to-intracranial (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize branches with in situ donor arteries, and reconstruct bifurcations with interposition grafts that are entirely intracranial. These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites toward a more local and reconstructive approach. IC-IC bypass can be utilized preferentially when revascularization is needed in the management of complex aneurysms. Experiences using IC-IC bypass, as applied to posterior inferior cerebellar artery (PICA) aneurysms in 35 patients, were reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients with PICA aneurysms and vertebral artery (VA) aneurysms involving the PICA\u2019s origin were identified from a prospectively maintained database of the Vascular Neurosurgery Service, and patients who underwent bypass procedures for PICA revascularization were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      During a 17-year period in which 129 PICA aneurysms in 125 patients were treated microsurgically, 35 IC-IC bypasses were performed as part of PICA aneurysm management, including in situ p3-p3 PICA-PICA bypass in 11 patients (31%), PICA reimplantation in 9 patients (26%), reanastomosis in 14 patients (40%), and 1 V\n                      <jats:sub>3<\/jats:sub>\n                      VA-to-PICA bypass with an interposition graft (3%). All aneurysms were completely or nearly completely obliterated, 94% of bypasses were patent, 77% of patients were improved or unchanged after treatment, and good outcomes (modified Rankin Scale \u2264 2) were observed in 76% of patients. Two patients died expectantly. Ischemic complications were limited to 2 patients in whom the bypasses occluded, and permanent lower cranial nerve morbidity was limited to 3 patients and did not compromise independent function in any of the patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>PICA aneurysms receive the application of IC-IC bypass better than any other aneurysm, with nearly one-quarter of all PICA aneurysms treated microsurgically at our center requiring bypass without a single EC-IC bypass. The selection of PICA bypass is almost algorithmic: trapped aneurysms at the PICA origin or p1 segment are revascularized with a PICA-PICA bypass, with PICA reimplantation as an alternative; trapped p2 segment aneurysms are reanastomosed, bypassed in situ, or reimplanted; distal p3 segment aneurysms are reanastomosed or revascularized with a PICA-PICA bypass; and aneurysms of the p4 segment that are too distal for PICA-PICA bypass are reanastomosed. Interposition grafts are reserved for when these 3 primary options are unsuitable. A constructive approach that preserves the PICA with direct clipping or replaces flow with a bypass when sacrificed should remain an alternative to deconstructive PICA occlusion and endovascular coiling when complete aneurysm occlusion is unlikely.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2015.5.jns15368","type":"journal-article","created":{"date-parts":[[2015,11,13]],"date-time":"2015-11-13T09:59:49Z","timestamp":1447408789000},"page":"1275-1286","source":"Crossref","is-referenced-by-count":81,"title":["Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients"],"prefix":"10.3171","volume":"124","author":[{"given":"Adib A.","family":"Abla","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron M.","family":"McDougall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D.","family":"Breshears","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Lawton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"Suppl","key":"b1-jns15368","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"93","DOI":"10.2176\/nmc.38.suppl_93","article-title":"Management of aneurysms of the vertebral artery-posterior inferior cerebellar artery complex","volume":"38","author":"Bertalanffy","year":"1998"},{"key":"b2-jns15368","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"991","DOI":"10.3171\/2012.12.JNS121240","article-title":"Endovascular treatment of proximal and distal posterior inferior cerebellar artery aneurysms","volume":"118","author":"Chalouhi","year":"2013"},{"key":"b3-jns15368","series-title":"Neurosurgery","first-page":"ons204","article-title":"Technical considerations in the endovascular management of aneurysms of the posterior inferior cerebellar artery","volume":"71","author":"Crowley","year":"2012"},{"key":"b4-jns15368","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"137","DOI":"10.3171\/jns.1995.82.1.0137","article-title":"Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation. Case report","volume":"82","author":"Durward","year":"1995"},{"key":"b5-jns15368","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"960","DOI":"10.3171\/jns.2003.99.6.0960","article-title":"Multimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage","volume":"99","author":"Hamada","year":"2003"},{"key":"b6-jns15368","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"496","DOI":"10.3171\/jns.1996.85.3.0496","article-title":"Reconstruction of the posterior inferior cerebellar artery in the treatment of giant aneurysms. Report of two cases","volume":"85","author":"Hamada","year":"1996"},{"key":"b7-jns15368","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"259","DOI":"10.3171\/jns.2002.97.2.0259","article-title":"Dissecting aneurysms of the vertebral artery: a management strategy","volume":"97","author":"Iihara","year":"2002"},{"key":"b8-jns15368","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.surneu.2003.06.001","article-title":"Treatment of vertebral artery aneurysms with posterior inferior cerebellar artery-posterior inferior cerebellar artery anastomosis combined with parent artery occlusion","volume":"61","author":"Kakino","year":"2004"},{"key":"b9-jns15368","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1227\/NEU.0000000000000312","article-title":"Revascularization and aneurysm surgery: techniques, indications, and outcomes in the endovascular era","volume":"74","author":"Kalani","year":"2014"},{"key":"b10-jns15368","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"348","DOI":"10.3174\/ajnr.A2741","article-title":"Stenting from the vertebral artery to the posterior inferior cerebellar artery","volume":"33","author":"Kim","year":"2012"},{"key":"b11-jns15368","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1227\/01.NEU.0000153927.70897.A2","article-title":"Thrombotic intracranial aneurysms: classification scheme and management strategies in 68 patients","volume":"56","author":"Lawton","year":"2005"},{"key":"b12-jns15368","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"178","DOI":"10.3171\/jns.1996.85.1.0178","article-title":"Treatment of aneurysms by excision or trapping with arterial reimplantation or interpositional grafting. Report of three cases","volume":"85","author":"Lee","year":"1996"},{"key":"b13-jns15368","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"219","DOI":"10.3171\/jns.2002.97.1.0219","article-title":"Cerebral revascularization performed using posterior inferior cerebellar artery-posterior inferior cerebellar artery bypass. Report of four cases and literature review","volume":"97","author":"Lemole","year":"2002"},{"key":"b14-jns15368","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"756","DOI":"10.3171\/jns.2002.97.4.0756","article-title":"Distal posterior inferior cerebellar artery aneurysms: clinical features and management","volume":"97","author":"Lewis","year":"2002"},{"key":"b15-jns15368","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1080\/02688690400022870","article-title":"Surgical management of ruptured and unruptured symptomatic posterior inferior cerebellar artery aneurysms","volume":"18","author":"Liew","year":"2004"},{"key":"b16-jns15368","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"1232","DOI":"10.3174\/ajnr.A2087","article-title":"Clinical outcomes of ruptured and unruptured vertebral artery-posterior inferior cerebellar artery complex dissecting aneurysms after endovascular embolization","volume":"31","author":"Lv","year":"2010"},{"key":"b17-jns15368","series-title":"AJNR Am J Neuroradiol","first-page":"527","article-title":"Endovascular treatment of isolated dissecting aneurysm of the posterior inferior cerebellar artery","volume":"27","author":"Maimon","year":"2006"},{"key":"b18-jns15368","series-title":"Neuroradiology","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1007\/s00234-002-0913-9","article-title":"Endovascular treatment of PICA aneurysms","volume":"45","author":"Mukonoweshuro","year":"2003"},{"key":"b19-jns15368","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1227\/01.NEU.0000084162.29616.43","article-title":"Surgical management of fusiform aneurysms of the peripheral posteroinferior cerebellar artery","volume":"53","author":"Nussbaum","year":"2003"},{"issue":"2 Suppl","key":"b20-jns15368","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"231","DOI":"10.3171\/jns.2005.102.2.0231","article-title":"Ruptured traumatic vertebral artery pseudoaneurysm in a child treated with trapping and posterior inferior cerebellar artery reimplantation. Case report and review of the literature","volume":"102","author":"O\u2019Shaughnessy","year":"2005"},{"key":"b21-jns15368","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"86","DOI":"10.3174\/ajnr.A0758","article-title":"Posterior inferior cerebellar artery aneurysms: incidence, clinical presentation, and outcome of endovascular treatment","volume":"29","author":"Peluso","year":"2008"},{"issue":"1 Suppl","key":"b22-jns15368","series-title":"Neurosurgery","first-page":"140","article-title":"In situ bypass in the management of complex intracranial aneurysms: technique application in 13 patients","volume":"57","author":"Qui\u00f1ones-Hinojosa","year":"2005"},{"key":"b23-jns15368","series-title":"AJNR Am J Neuroradiol","first-page":"1421","article-title":"Endovascular management of vertebrobasilar dissecting aneurysms","volume":"24","author":"Rabinov","year":"2003"},{"key":"b24-jns15368","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.wneu.2012.09.010","article-title":"Distal aneurysms of intracranial arteries: application of numerical nomenclature, predilection for cerebellar arteries, and results of surgical management","volume":"80","author":"Rodr\u00edguez-Hern\u00e1ndez","year":"2013"},{"key":"b25-jns15368","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1227\/01.NEU.0000348557.11968.F1","article-title":"Bypass surgery for complex brain aneurysms: an assessment of intracranial-intracranial bypass","volume":"65","author":"Sanai","year":"2009"},{"key":"b26-jns15368","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1016\/j.jocn.2003.12.019","article-title":"Treatment of vertebral artery dissecting aneurysms presenting with progressive myelopathy","volume":"11","author":"Shin","year":"2004"},{"key":"b27-jns15368","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1227\/NEU.0b013e31822bb8a6","article-title":"Giant intracranial aneurysms: evolution of management in a contemporary surgical series","volume":"69","author":"Sughrue","year":"2011"},{"issue":"5 Suppl 2","key":"b28-jns15368","series-title":"Neurosurgery","first-page":"301","article-title":"Microsurgical management of incompletely coiled and recurrent aneurysms: trends, techniques, and observations on coil extrusion","volume":"64","author":"Waldron","year":"2009"},{"key":"b29-jns15368","series-title":"Neurol India","doi-asserted-by":"publisher","first-page":"15","DOI":"10.4103\/0028-3886.128247","article-title":"Long-term outcomes of trapping vertebral artery-posterior inferior cerebellar artery dissecting aneurysms after revascularization","volume":"62","author":"Wang","year":"2014"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/124\/5\/article-p1275.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/124\/5\/article-p1275.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/124\/5\/article-p1275.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,9]],"date-time":"2024-03-09T04:55:52Z","timestamp":1709960152000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/124\/5\/article-p1275.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,5]]},"references-count":29,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2015.5.jns15368","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,5]]}}}