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Minimally Invasive Occipital Artery to C1-C2 V3 Bypass: 2-Dimensional Operative Video
Journal article   Peer reviewed

Minimally Invasive Occipital Artery to C1-C2 V3 Bypass: 2-Dimensional Operative Video

Mario Zanaty, Yair Gozal and Ondrej Choutka
Operative neurosurgery (Hagerstown, Md.), Vol.23(3), pp.E178-E178
09/01/2022
DOI: 10.1227/ons.0000000000000313
PMID: 35972104

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Abstract

Traditionally, the occipital artery (OA) to vertebral artery bypass is performed using longer incision to connect the OA to the oblique segment of V3 between the occiput and C1. Alternatively, 2 incisions can be used, and a jump graft is used to connect the external cerebral artery with the vertebral artery. Here, we performed a small incision and connected the proximal OA to the V3 situated between C1 and C2 (vertical segment). The patient is a 69-year-old man with a history of bilateral cerebellar strokes due to a left vertebral artery dissection. He presented later with a new pontine stroke despite maximal medical therapy. The CTA showed bilateral V2 occlusion with retrograde filling and worsening basilar artery stenosis. He was indicated for a bypass to augment the flow in the trapped segment between the vertebral artery occlusion and the basilar stenosis. In addition, this could serve as a conduit for endovascular therapy of the basilar stenosis if needed. An angiogram postoperatively showed good anterograde filling through the bypass with resolution of the basilar artery stenosis, suggesting that the basilar stenosis was a functional one. The patient is 4 years postoperative with no recurrence. His weakness has resolved, and he has returned to work. The techniques are presented in the video. The patient consented to procedure and publications of images and video.
 Surgery Clinical Neurology Life Sciences & Biomedicine Neurosciences & Neurology Science & Technology

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