case_images: PMC11090530_01
case_images: (a) Posterior view of computed tomography angiography on admission demonstrates bilateral vertebral dissection aneurysm (arrows); (b) Posterior view of computed tomography angiography on hospital days 3 (arrows); (c) Posterior view of computed tomography angiography on hospital days 11 reveals that the right vertebral dissection aneurysm is rapidly enlarging (arrows); (d) A lateral view of right vertebral angiography reveals a perforating artery to the medulla oblongata from the distal part of the right vertebral dissection aneurysm (arrows) and hypoplastic precommunicating segment of the posterior cerebral arteries.
case_images: SNI-15-121-g001.jpg
case_images: PMC11090530_01_SNI-15-121-g001.jpg
case_images: F1
case_images: Computed tomography angiography (CTA) revealed a bilateral VADA [Figure 1a]. Follow-up CTA revealed left PICA and obliteration of the left VADA on postoperative day 2 [Figure 1b]. However, on postoperative day 11, follow-up CTA revealed asymptomatic enlargement of the contralateral VADA [Figure 1c]. The perforating arteries from the distal part of the right VADA to the medulla oblongata, fetal-type posterior communicating arteries (PCOMs), and hypoplastic precommunicating segment of both the posterior cerebral arteries (P1) were revealed on digital subtraction angiography [Figure 1d].
case_images: (a) Skin incision line for right superficial temporal artery-superior cerebellar artery (SCA) bypass and proximal clipping of the right vertebral dissection aneurysm; (b) Intraoperative findings of a right superficial temporal artery (arrows)-SCA (arrows head) bypass. The interruption time of a right SCA during the bypass was 28 min; (c) Intraoperative findings of proximal clipping distal to the posterior inferior cerebellar artery (arrows); (d) Intraoperative findings of right vertebral dissection aneurysm and the perforator from the distal part to the brain stem (arrows).
case_images: SNI-15-121-g002.jpg
case_images: PMC11090530_01_SNI-15-121-g002.jpg
case_images: F2
case_images: The right STA-SCA bypass was performed first using a subtemporal approach [Figures 2a and b]. PICA was performed after completion of the STA-SCA bypass [Figure 2c]. Parts of the proximal VADA vessel walls were thin, indicating a high risk of rupture. We found perforating arteries in the right VADA [Figure 2d].
case_images: Posterior view of computed tomography angiography demonstrates bilateral vertebral dissection aneurysm obliteration and patent superficial temporal artery-superior cerebellar artery bypass graft (arrows).
case_images: SNI-15-121-g003.jpg
case_images: PMC11090530_01_SNI-15-121-g003.jpg
case_images: F3
case_images: The bilateral VADA was obliterated, and the patent STA-SCA bypass flow was observed using CTA [Figure 3].