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

Abstract

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.

STA-MCA bypass following sphenoid wing meningioma resection: A case report

“…There were a few cases of skull base tumors requiring vessel revascularization. In a recent systematic review, Wolfswinskel et al showed that only about 368 cases of EC-IC bypass due to vessel injury for skull base tumors resection were reported from 1950 to 2018 [4]. According to Sekhar, there were 130 revascularization cases for tumors from 1988 to 2006 [5].…”

“…Skull base tumors include pituitary tumors, sellar/parasellar tumors, meningioma, chordomas, chondrosarcomas, and squamous cell carcinoma… Most of the vessel revascularization cases were meningiomas [4]. This is because of the variety in their behaviors resulting in different vessel encasement.…”

When is a multidisciplinary surgical approach required in sinonasal tumours with cranial involvement?

“…In patients who would not tolerate ICA occlusion, adequate counselling on potential morbidity and mortality is mandatory and strategies such as endovascular flow diverter protective stenting or extracranial-to-intracranial bypass surgery should be considered when surgery can be staged or delayed while the patient undergoes double antiplatelet therapy (Fig. 4) 49,50 .…”

3D-printed cranial models simulating operative field depth for microvascular training in neurosurgery

“…Diseases requiring deep field operations include: Cavernous malformations in the cerebral peduncles,[ 8 ] midbrain,[ 17 ] pons,[ 46 ] and other cavernomas of the brainstem[ 23 ] Arteriovenous malformations in the basal ganglia, thalamus,[ 27 ] choroid plexus,[ 13 ] brain stem,[ 18 ] and cerebellum[ 43 ] Complex aneurysms of the anterior inferior cerebellar artery,[ 24 ] posterior inferior cerebellar artery,[ 41 ] basilar artery,[ 26 ] and middle cerebral artery[ 20 ] Skull base tumors. [ 32 , 42 ] …”