• Yasuaki Inoue and Kazuhito Matsuzawa.
• Department of Neurosurgery, Nadogaya Hospital, Kashiwa, Chiba, Japan. Electronic address: inoue.yasuaki@gmail.com.
• World Neurosurg. 2019 Mar 1; 123: 64-66.

BackgroundIschemic symptoms caused by traumatic vertebral artery dissection after cervical maneuvers are treated medically and surgically. This is a report of the infrequently documented occipital to vertebral artery bypass to stop the transient ischemic attacks following traumatic vertebral artery dissection.Case DescriptionA 33-year-old man presented with a sudden right posterior neck pain following a sudden neck movement, accompanied by left lower quadrant anopsia and rotational vertigo. The neurologic symptoms had already been resolved on arrival. Magnetic resonance imaging and digital subtraction angiography revealed an extracranial vertebral artery dissection with no evidence of cerebral infarction. Although medical therapy was initiated, he repeatedly complained of ischemic symptoms. A bypass was performed from the occipital artery to the atlas loop of the vertebral artery with distal occlusion of the lesion. The patient was neurologically intact after the surgery, and magnetic resonance imaging showed no cerebral infarction.ConclusionA bypass from the occipital artery to the atlas loop of the vertebral artery is an effective procedure for traumatic extracranial vertebral artery dissection with ischemic symptoms.Copyright © 2018 Elsevier Inc. All rights reserved.

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