Intracranial In Situ Side-to-Side Microvascular Anastomosis: Principles, Operative Technique, and Applications

Ramanathan, Dinesh; Hegazy, Ahmed; Mukherjee, Sudipta Kumar; Sekhar, Laligam N.

doi:10.1016/j.wneu.2010.01.025

Cited by 25 publications

(13 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…An optimal bypass matches the diameters of donor and recipient arteries. 26,27 Our results show that recipient arteries on Zones I and II match the diameter of the ATAs. This implies that in cases of a proximal MCA occlusion, an early ATA can be optimal for revascularization of the distal MCA, preferably on insular Zones I and II.…”

Section: Maximal Mobility Of Early Atamentioning

confidence: 51%

The anterior temporal artery: an underutilized but robust donor for revascularization of the distal middle cerebral artery

Meybodi¹,

Lawton²,

Griswold³

et al. 2017

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVE The anterior temporal artery (ATA) supplies an area of the brain that, if sacrificed, does not cause a noticeable loss of function. Therefore, the ATA may be used as a donor in intracranial-intracranial (IC-IC) bypass procedures. The capacities of the ATA as a donor have not been studied previously. In this study, the authors assessed the feasibility of using the ATA as a donor for revascularization of different segments of the distal middle cerebral artery (MCA). METHODS The ATA was studied in 15 cadaveric specimens (8 heads, excluding 1 side). First, the cisternal segment of the artery was untethered from arachnoid adhesions and small branches feeding the anterior temporal lobe and insular cortex, to evaluate its capacity for a side-to-side bypass to insular, opercular, and cortical segments of the MCA. Any branch entering the anterior perforated substance was preserved. Then, the ATA was cut at the opercular-cortical junction and the capacity for an end-to-side bypass was assessed. RESULTS From a total of 17 ATAs, 4 (23.5%) arose as an early MCA branch. The anterior insular zone and the frontal parasylvian cortical arteries were the best targets (in terms of mobility and caliber match) for a side-to-side bypass. Most of the insula was accessible for end-to-side bypass, but anterior zones of the insula were more accessible than posterior zones. End-to-side bypass was feasible for most recipient cortical arteries along the opercula, except for posterior temporal and parietal regions. Early ATAs reached significantly farther on the insular MCA recipients than non-early ATAs for both side-to-side and end-to-side bypasses. CONCLUSIONS The ATA is a robust arterial donor for IC-IC bypass procedures, including side-to-side and end-to-side techniques. The evidence provided in this work supports the use of the ATA as a donor for distal MCA revascularization in well-selected patients.

show abstract

Section: Maximal Mobility Of Early Atamentioning

confidence: 51%

The anterior temporal artery: an underutilized but robust donor for revascularization of the distal middle cerebral artery

Meybodi¹,

Lawton²,

Griswold³

et al. 2017

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…Anastomosis is usually chosen for flow replacement after clipping of a complex aneurysm, thus, preventing small vessel occlusion or stenosis. This procedure is basically done during clipping of complex anterior communicating aneurysm or in posterior circulation aneurysm [1]. Side-to-side approximation without creating tension or stenosis at the anastomosis site in side-to-side procedure carries potential technical difficulty.…”

Section: Discussionmentioning

confidence: 99%

“…It has been an essential procedure for the management of occlusive cerebrovascular diseases for revascularization and bypass surgery when collateral circulation is inadequate in substituting blood flow after permanent vessel occlusion. Yasargil, in 1967 [1], first put forth the hypothesis of cerebral revascularization. The concept and techniques for bypass surgeries have evolved since for reconstruction of both the anterior and posterior circulations.…”

Section: Introductionmentioning

confidence: 99%

Learning Microvascular Anastomosis in Low Socioeconomic Vascular Models During Residency

Tamrakar

2017

Cureus

View full text Add to dashboard Cite

Microvascular anastomosis procedure has become an essential practice for the management of most neurovascular diseases. Increasing use of neurosurgical techniques necessitates intensive laboratory training in microsurgery.Umbilical artery is used for quantifiable representation to set up microvascular anastomosis model for the beginners. These arteries are found to be between 4 and 5 mm in diameter. Chicken wings are set up as second anastomosis model. Five to six centimeter long brachial artery extracted from a chicken is measured approximately 1-2 mm in diameter. These arteries are practiced for end-to-end, end-to-side, or side-to-side anastomosis under the microscope.Umbilical cord and chicken wing model hold several advantages. These essentials are inexpensive, convenient to manage, and easy to obtain for educational purposes. They neither need detailed facilities for maintenance like in animal model nor any anesthetic prerequisite. Moreover, the diameter and structure of the material are identical to those of human cortical vessels.Low-cost laboratory training during residency is more relevant in source restraint areas. It has several added benefits in refining the procedural dexterity on anastomosing smaller size vessel identical to a cortical vessel of middle cerebral artery and distal branches of the superficial temporal artery.

show abstract

“…The ideal surgical technique is to make an artificial conduit for blood flow between two adjacent vessels of similar caliber. This type of in situ bypass has been often applied for the treatment of complex brain aneurysms6,7).…”

Section: Discussionmentioning

confidence: 99%

“…However, both treatment modalities may be impossible in certain situations, such as giant or fusiform thrombosed aneurysm, in which efferent or adjacent arterial branches may be involved. Under these situations, an alternative surgical strategy using revascularization may be required6,7). Although revascularization using harvested graft vessels has been used for high-flow replacement in proximal vessels, local techniques of revascularization without a graft ( in situ ) may be sometimes more useful for distally located aneurysm.…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment of Giant Serpentine Aneurysm of A2-A3 Segment Distal Anterior Cerebral Artery : Technical Case Report

Moon

Kim

Joo

2012

J Korean Neurosurg Soc

View full text Add to dashboard Cite

ObjectiveTo report our surgical experience using in situ end-to-side bypass for giant serpentine distal anterior cerebral artery aneurysm, unsuitable for microsurgical clipping.MethodsA 49-year-old woman presented with headache and intermittent loss of consciousness. The brain computed tomography scan revealed a partially calcified mass in the interhemispheric fissure. On cerebral angiography, that was giant (30×18 mm sized), serpentine aneurysm originating from the A2 to A3 segment of the distal anterior cerebral artery (DACA). The aneurysm was trapped with clips, and the right A3 segment to left A3 segment of DACA, end-to-side in situ bypass was performed. Surgical result was favorable, with no newly developed ischemic event in the acute recovery period. Postoperative angiography showed total occlusion of the aneurysm and good patency, with preserved distal flow.ConclusionGiant fusiform aneurysms of the DACA are extremely rare and can be particularly challenging to treat. End-to-side A3 : A3 bypass with aneurysm trapping could be a treatment modality for these locations.

show abstract

Intracranial In Situ Side-to-Side Microvascular Anastomosis: Principles, Operative Technique, and Applications

Cited by 25 publications

References 16 publications

The anterior temporal artery: an underutilized but robust donor for revascularization of the distal middle cerebral artery

The anterior temporal artery: an underutilized but robust donor for revascularization of the distal middle cerebral artery

Learning Microvascular Anastomosis in Low Socioeconomic Vascular Models During Residency

Surgical Treatment of Giant Serpentine Aneurysm of A2-A3 Segment Distal Anterior Cerebral Artery : Technical Case Report

Contact Info

Product

Resources

About