External Carotid Artery-Saphenous Vein Graft-M2/M2 Triple-Vessel Anastomosis and Trapping of Complex Middle Cerebral Artery Aneurysm: 360° Virtual Reality–Enhanced Operative Video

Nguyen, Vincent N.; Rennert, Robert C.; Sternbach, Sarah; Sizdahkhani, Saman; Chung, Lawrance K.; Khahera, Anadjeet S.; Hopkins, Benjamin S.; Abedi, Aidin; Atai, Nadia; Russin, Jonathan J.

doi:10.1227/ons.0000000000000857

Operative Neurosurgery

2023

DOI: 10.1227/ons.0000000000000857

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External Carotid Artery-Saphenous Vein Graft-M2/M2 Triple-Vessel Anastomosis and Trapping of Complex Middle Cerebral Artery Aneurysm: 360° Virtual Reality–Enhanced Operative Video

Vincent N. Nguyen,

Robert C. Rennert,

Sarah Sternbach

et al.

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2023

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Three-Vessel Anastomosis for Direct Multiterritory Cerebral Revascularization: Case Series

Rennert,

Atai,

Nguyen

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVE: Cerebral revascularization of multiple territories traditionally requires multiple constructs, serial anastomoses, or a combination of direct and indirect approaches. A novel 3-vessel anastomosis technique allows for direct, simultaneous multiterritory cerebral revascularization using a single interposition graft. We herein present our experience with this approach. METHODS: Retrospective review of perioperative data and outcomes for patients undergoing multiterritory cerebral revascularization using a 3-vessel anastomosis from 2019 to 2023. RESULTS: Five patients met inclusion criteria (median age 53 years [range 12-73]). Three patients with complex middle cerebral artery aneurysms (1 ruptured) were treated with proximal ligation or partial/complete clip trapping and multiterritory external carotid artery-M2-M2 revascularization using a saphenous vein interposition graft. Two patients with moyamoya disease, prior strokes, and predominately bilateral anterior cerebral artery hypoperfusion were treated with proximal superficial temporal artery-A3-A3 revascularization using a radial artery or radial artery fascial flow-through free flap graft. No patients experienced significant surgery-related ischemia. Bypass patency was 100%. One patient had new strokes from vasospasm after subarachnoid hemorrhage. One patient required a revision surgery for subdural hematoma evacuation and radial artery fascial flow-through free flap debridement, without affecting bypass patency or neurologic outcome. On hospital discharge, median Glasgow Outcome Scale and modified Rankin Scale scores were 4 (range 3-5) and 2 (range 0-5), respectively. On follow-up, 1 patient died from medical complications of their presenting stroke; Glasgow Outcome Scale and modified Rankin Scale scores were otherwise stable or improved. CONCLUSION: The 3-vessel anastomosis technique can be considered for simultaneous revascularization of multiple intracranial territories.

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Three-Vessel Anastomosis for Direct Multiterritory Cerebral Revascularization: Case Series

Rennert,

Atai,

Nguyen

et al. 2023

Operative Neurosurgery

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External Carotid Artery-Saphenous Vein Graft-M2/M2 Triple-Vessel Anastomosis and Trapping of Complex Middle Cerebral Artery Aneurysm: 360° Virtual Reality–Enhanced Operative Video

Cited by 1 publication

References 11 publications

Three-Vessel Anastomosis for Direct Multiterritory Cerebral Revascularization: Case Series

Three-Vessel Anastomosis for Direct Multiterritory Cerebral Revascularization: Case Series

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