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We report a case in which a radial artery bypass graft was used to treat a basilar artery trunk dissecting aneurysm. The patient, a 73-year-old man, was transferred to our hospital because of disturbance of consciousness. A CT scan on admission showed subarachnoid hemorrhage in the prepontine cistern and interpeduncular cistern (Fisher group II). Left vertebral angiography revealed a large irregular-shaped dissecting aneurysm that extended from the anterior inferior cerebellar artery (AICA) to the basilar artery bifurcation. We decided to perform a delayed operation because the neurological grade was very poor (Hunt & Kosnik grade: V). Follow-up left vertebral angiography 4 weeks after admission showed that the aneurysm had become saccular in shape. A radical operation was scheduled because the risk of rebleeding from this aneurysm was considered to be relatively high. The operation was performed via a transpetrosal approach with the use of VA-RA (radial artery)-PCA bypass. First, the aneurysm was trapped, and then it was clipped because pulse-pressure on perfusion pressure of the superior cerebellar artery (SCA) became almost zero. Postoperative angiography revealed another unclipped aneurysm, and a second operation was therefore performed. Angiography after the second operation showed that both aneurysms had disappeared. Finally, we clipped the saccular aneurysms using a VA-RA-PCA bypass. Monitoring of the perfusion pressure of SCA was very useful for deciding whether to perform clipping or trapping of the basilar artery trunk aneurysm.

Usefulness of Intraoperative Monitoring of Perfusion Pressure for Basilar Artery Trunk Aneurysm. A Case Report.