Combined Direct and Indirect Cerebral Revascularization Using Local and Flow-Through Flaps

Azadgoli, Beina; Leland, Hyuma A.; Bakhsheshian, Joshua; Russin, Jonathan J.; Carey, Joseph N.

doi:10.1055/s-0037-1606552

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…When managing these challenging pathologies, it is important to remember that cooperation between plastic surgeons, head and neck surgeons, vascular surgeons, and neurosurgeons has been demonstrated to improve outcomes . By taking advantage of each subspecialty's experience and expertize, improvements and innovations can be made.…”

Section: Innovations and Improvementsmentioning

confidence: 99%

“…However, improved techniques to support the use of EC‐IC bypass for flow augmentation and vessel replacement have continued to develop. For example, our group recently published the use of local and flow‐through flaps for cerebral revascularization as an additional tool to provide direct and indirect revascularization and/or soft tissue coverage . Sekhar's group reported multiple developments and improvements in technique including distal anastomosis to the M1 or M2, the ICA or ECA for proximal anastomosis of bypass based on collateral flow augmentation, a pressure distension technique, and the benefits of intraoperative angiography .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

EC‐IC bypass for cerebral revascularization following skull base tumor resection: Current practices and innovations

Wolfswinkel

Landau

Rāviņa

et al. 2018

Journal of Surgical Oncology

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Complex skull base tumors can involve critical vessels of the head and neck. To achieve a gross total resection, vessel sacrifice may be necessary. In cases where vessel sacrifice will cause symptomatic cerebral ischemia, surgical revascularization is required. The purpose of this paper is to review cerebral revascularization for skull base tumors, the indications for these procedures, outcomes, advances, and future directions.

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Section: Innovations and Improvementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

EC‐IC bypass for cerebral revascularization following skull base tumor resection: Current practices and innovations

Wolfswinkel

Landau

Rāviņa

et al. 2018

Journal of Surgical Oncology

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“…Pedicled temporoparietal fascial flap (TPFF) has been widely used for head and neck flap reconstruction in plastic surgery, due to its free, flexible, thin, and highly vascularized characteristics (9). In view of the above characteristics of the TPFF, some neurosurgeons have tried to replace the TPFF in the revascularization in MMA and succeeded (10)(11)(12). However, few reports have been published, as the technique is still in the exploratory stage.…”

Section: Introductionmentioning

confidence: 99%

Modified pedicled temporoparietal fascial flap combined revascularization in adult moyamoya angiopathy

Zhang¹,

Tong²,

Wang³

et al. 2022

Ann Transl Med

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Background: Pedicled temporoparietal fascial flaps (TPFF), which are flexible, thin, and highly vascularized, have been tried for the moyamoya angiopathy (MMA) treatment. To reduce postoperative complications and improve prognosis, we performed surgical modification and followed up to observe the efficacy.Methods: From February 2018 and June 2022, the clinical data of 31 adult MMA patients who underwent the modified TPFF combined revascularization were collected. The clinical outcomes and complications of the patients were recorded until the cut-off date of follow-up. The primary endpoints were the magnetic resonance perfusion (MRP), modified Rankin Scale (mRS) scores, and Matsushima Grade; the secondary endpoints were the clinical symptom outcome and Postoperative complications. Descriptive statistics and rank sum test to assess the therapeutic effect of the modified TPFF combined revascularization for adult MMA treatment. Results:The clinical symptoms of MMA were alleviated in 26 patients and disappeared in five. In all patients, MRP showed improvement in cerebral perfusion on the operated side, and no deterioration or new cerebral infarction occurred during follow-up. Postoperative digital subtraction angiography (DSA) showed that the anastomotic site was patent, and the MMA collateral was decreased in all patients. Only 1 case (3%) of Matsushima grade C showed poor collateral compensation. The admission mRS score (1.54±0.66) of the ischemic MMA was significantly reduced compared with ≥6 months postoperatively (0.54±0.72, P<0.01).The admission mRS score (0.57±0.53) of the hemorrhagic MMA was reduced compared with ≥6 months postoperatively (0, P<0.05). Postoperative complications included epileptic seizures in 2 cases, a cerebral hyper-perfusion syndrome in 2 cases, intracranial rebleeding in 2 cases, skin necrosis in 1 case, and skin maceration in 1 case.Conclusions: Modified TPFF combined revascularization might be a feasible and safe surgical technique for MMA, but it is still necessary to increase the sample size and extend the follow-up time to evaluate its efficacy. Ischemic MMA may have a more significant prognostic benefit than hemorrhagic MMA by this surgery.

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Radial Artery Fascial Flow-Through Free Flap for Complex Cerebral Revascularization: Technical Notes and Long-Term Neurologic and Radiographic Outcomes

Rennert

Rāviņa²,

Strickland³

et al. 2018

Oper. Neurosurg.

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Combined Direct and Indirect Cerebral Revascularization Using Local and Flow-Through Flaps

Abstract: The level of evidence is IV.

Cited by 3 publications

References 13 publications

EC‐IC bypass for cerebral revascularization following skull base tumor resection: Current practices and innovations

EC‐IC bypass for cerebral revascularization following skull base tumor resection: Current practices and innovations

Modified pedicled temporoparietal fascial flap combined revascularization in adult moyamoya angiopathy

Radial Artery Fascial Flow-Through Free Flap for Complex Cerebral Revascularization: Technical Notes and Long-Term Neurologic and Radiographic Outcomes

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