Cerebral bypass and vascular reconstructions for posterior circulation aneurysms

Posterior circulation aneurysms are among the most challenging problems facing the cerebrovascular neurosurgeon. Aneurysms of the vertebrobasilar system may be broad-necked or fusiform, and may involve critical branches, such as the cerebellar vessels, brainstem perforators, or the posterior cerebral arteries (PCAs). Furthermore, optimal exposure of these lesions often requires specialized expertise in cranial-base anatomy and microvascular surgery. Parent vessel or perforator occlusion may result in a devastating stroke or death. Direct surgical repair, Hunterian ligation or trapping, and endovascular stenting or coiling are treatment options that may not always be feasible [1]. These challenges and the poor natural history of symptomatic posterior fossa aneurysms have fueled interest in continuing the development of techniques of posterior circulation revascularization to improve the management of these difficult cases.