Reconstruction of intracranial vertebral artery with radial artery and occipital artery grafts for fusiform intracranial vertebral aneurysm not amenable to endovascular treatment: technical note

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Symptomatic fusiform intracranial vertebral artery aneurysms pose a formidable treatment challenge when not amenable to endovascular treatment. In this paper, we illustrate the microsurgical management of such an aneurysm.


To prevent neurological deterioration, anatomical reconstruction preserving all vessels including posterior inferior cerebellar artery and perforators is essential. In this case illustration, the occipital artery was used as a donor to a perforator originating from the aneurysmal segment. This bypass was performed in an end-to-side fashion. Subsequently, the aneurysmal component of the vertebral artery was resected and an end-to-side (V4 to V3) bypass was performed using a radial artery graft.


The patient achieved complete resection of the aneurysm preserving normal anatomy of the posterior circulation without any ischemic complications.


Complex cerebral artery bypass techniques are essential in the armamentarium of cerebrovascular for the treatment of complex lesions not amenable to endovascular therapy.

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Conflicts of interest


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Correspondence to Hisashi Kubota.

Additional information


The authors describe that high-flow bypass surgery in the era of intracranial stenting still can be an alternative and not inferior strategy in patients suffering from fusiform cerebral aneurysms. As the main message, the authors underlined that case selection as well as the experience of the team is of major importance to achieve an outstanding result with acceptable morbidity.

Daniel Hänggi

Duesseldorf, Germany

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Kubota, H., Tanikawa, R., Katsuno, M. et al. Reconstruction of intracranial vertebral artery with radial artery and occipital artery grafts for fusiform intracranial vertebral aneurysm not amenable to endovascular treatment: technical note. Acta Neurochir 155, 1517–1524 (2013).

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  • Fusiform intracranial vertebral artery aneurysm
  • Vertebral artery reconstruction
  • Radial artery
  • Occipital artery
  • Perforator
  • Bypass