High flow extracranial-to-intracranial brain bypass surgery

Sia, Sheau Fung; Morgan, M.

doi:10.1016/j.jocn.2012.05.007

Cited by 68 publications

(25 citation statements)

References 58 publications

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“…Emergency revascularization for unplanned vessel loss or stroke progression and 3. Augmentation of cerebral blood flow for chronic hemodynamic ischemia, which is not amenable for conventional surgery [5]. In this case, emergency EC-IC bypass was performed for unplanned intraoperative ICA loss.…”

Section: Discussionmentioning

confidence: 98%

“…It is mostly performed in a well-prepared setting unless in some emergency situations. Therefore, reports about urgent high-flow EC-IC bypass are few [5,6]. In this report, we performed emergency high-flow EC-IC bypass from left common carotid artery to middle cerebral artery in order to rescue the territory of the perforated internal carotid artery.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Emergency Extracranial-Intracranial Bypass during Surgery for Anterior Clinoid Process Hemangiopericytoma with ICA InvasionÂ—Case Report

Chen¹,

Lee²,

Chen³

et al. 2015

J Neurol Disord

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Emergency Extracranial-Intracranial Bypass during Surgery for Anterior Clinoid Process Hemangiopericytoma with ICA InvasionÂ—Case Report

Chen¹,

Lee²,

Chen³

et al. 2015

J Neurol Disord

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“…9,10 There are two major indications for EC-IC bypass surgery: (1) flow augmentation and (2) flow replacement. 7 High-flow bypass followed by ligation of the ICA is an effective treatment, but the impact of abrupt occlusion of the ICA is unpredictable, especially on postoperative cognitive function. HFB followed by ICA ligation can achieve good clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…for giant ICA aneurysms. 7 Such treatment may be associated with many complications such as graft occlusion, hemorrhage, infarct, ophthalmoplegia, hyperperfusion syndrome, cognitive disturbance, etc. We report a case that developed postoperative mono-ocular blindness after having EC-IC HFB with ICA ligation at the neck.…”

Section: Introductionmentioning

confidence: 99%

Extracranial-Intracranial High-Flow Bypass with Internal Carotid Artery Ligation at Neck for Giant Cavernous Internal Carotid Artery Dissecting Aneurysm in a Teen Girl with Postoperative Unusual Complication of Mono-ocular Blindness: A Case Report

Chowdhury

Ekramullah

Khalil

et al. 2019

IJNS

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Extracranial-intracranial (EC-IC) high-flow bypass with internal carotid artery (ICA) ligation at the neck is an important treatment option for giant cavernous ICA dissecting aneurysm. Such treatment may be associated with many complications. We report a case that developed postoperative mono-ocular blindness. So far to our knowledge such complication has not been reported in the literature. A 14-year-old girl presented with recent headache, eye ache, occasional double vision, and occasional right-sided visual impairment. Neurologic examination revealed no abnormality. Computed tomographic (CT) scan of the head showed a large, right parasellar, and mostly hyperdense space-occupying lesion. CT angiogram of the brain showed giant dissecting aneurysm of right-sided cavernous segment ICA. A right-sided external carotid artery–radial artery graft–middle cerebral artery (ECA-RAG-MCA [M2]) high-flow bypass was done with ligation of the right ICA in the neck. Postoperatively, the patient developed complete, mono-ocular, and permanent blindness on right side. Mono-ocular blindness is a serious complication from ophthalmic/central retinal artery thrombosis in high-flow EC-IC bypass with ICA ligation. Strategy is required to find and to set for its prevention.

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“…In cases in which the target of the bypass is flow replacement, a higher flow bypass graft is often required 14,15. In these cases, the cervical carotid artery is typically used as the donor site, using either a saphenous vein or radial artery as a graft vessel, which is then anastomosed to an appropriate recipient MCA branch 1,2,14,16. This technique typically requires a graft in excess of 20 cm, which can be prone to kinking and subcutaneous compression.…”

Section: Discussionmentioning

confidence: 99%

Internal Maxillary Artery-Middle Cerebral Artery Bypass

et al. 2014

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BACKGROUND:Internal maxillary artery (IMax)–middle cerebral artery (MCA) bypass has been recently described as an alternative to cervical extracranial-intracranial bypass. This technique uses a “keyhole” craniectomy in the temporal fossa that requires a technically challenging end-to-side anastomosis.OBJECTIVE:To describe a lateral subtemporal craniectomy of the middle cranial fossa floor to facilitate wide exposure of the IMax to facilitate bypass.METHODS:Orbitozygomatic osteotomy is used followed by frontotemporal craniotomy and subsequently laterotemporal fossa craniectomy, reaching its medial border at a virtual line connecting the foramen rotundum and foramen ovale. The IMax was identified by using established anatomic landmarks, neuronavigation, and micro Doppler probe (Mizuho Inc. Tokyo, Japan). Additionally, we studied the approach in a cadaveric specimen in preparation for microsurgical bypass.RESULTS:There were 4 cases in which the technique was used. One bypass was performed for flow augmentation in a hypoperfused hemisphere. The other 3 were performed as part of treatment paradigms for giant middle cerebral artery aneurysms. Vein grafts were used in all patients. The proximal anastomosis was performed in an end-to-side fashion in 1 patient and end-to-end in 3 patients. Intraoperative graft flow measured with the Transonic flow probe ranged from 20 to 60 mL/min. Postoperative angiography demonstrated good filling of the graft with robust distal flow in all cases. All patients tolerated the procedure well.CONCLUSION:IMax to middle cerebral artery subcranial-intracranial bypass is safe and efficacious. The laterotemporal fossa craniectomy technique resulted in reliable identification and wide exposure of the IMax, facilitating the proximal anastomosis.ABBREVIATIONS:EC-IC, extracranial-intracranialIMax, internal maxillary arteryMCA, middle cerebral arterySC-IC, subcranial-intracranialSTA, superficial temporal artery

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High flow extracranial-to-intracranial brain bypass surgery

Cited by 68 publications

References 58 publications

Emergency Extracranial-Intracranial Bypass during Surgery for Anterior Clinoid Process Hemangiopericytoma with ICA InvasionÂ—Case Report

Emergency Extracranial-Intracranial Bypass during Surgery for Anterior Clinoid Process Hemangiopericytoma with ICA InvasionÂ—Case Report

Extracranial-Intracranial High-Flow Bypass with Internal Carotid Artery Ligation at Neck for Giant Cavernous Internal Carotid Artery Dissecting Aneurysm in a Teen Girl with Postoperative Unusual Complication of Mono-ocular Blindness: A Case Report

Internal Maxillary Artery-Middle Cerebral Artery Bypass

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