The “bonnet bypass”

Abstract

A saphenous vein bypass graft from the contralateral superficial temporal artery to the ipsilateral middle cerebral artery was performed in a patient who required occlusion of his left common carotid artery. This procedure was used because of the unavailability of an ipsilateral donor artery. The bypass is working well 8 months postoperatively.

High flow extracranial-to-intracranial brain bypass surgery

“…Venous bypass graft between CCA to intracranial ICA 1978 23 1. ICA to cortical branch of MCA bypass with SVG 2.ECA to MCA with synthetic tube of PTFE 1980 24,25 Subclavian artery to MCA using saphenous vein and Bonnet bypass 1980 26 Bypass between the cervical and petrous ICA 1982 27 SVG for posterior circulation disease 1986 28 Treatment of intracranial aneurysms by combined proximal ligation and EC-IC bypass with vein graft 1990 29 Bypass between the petrous and supraclinoid ICA 1990 30 Venous bypass for intracavernous or unclippable giant aneurysms of ICA 1996 31 Interposition saphenous vein bypass graft between the common and end-to-end intracranial ICA 1996 32 Cervical-to-petrous ICA saphenous vein in situ bypass 1996 33 ELANA …”

Microsurgical anatomy of cerebral revascularization. Part I: Anterior circulation

“…43 The bonnet bypass is performed either for a lowflow or high-flow bypass, depending on the donor artery. 26,49 On the other hand, cerebral revascularization techniques are also divided into two types, depending on whether the graft materials are pedicled arterial grafts, such as STA and occipital artery grafts, or free venous or arterial grafts, which are usually saphenous vein grafts. The pedicled arterial grafts are mainly used for low-flow bypasses, whereas the free venous or arterial grafts are used for high-flow bypass.…”

Interposition Grafts and Aneurysms

“…Multiple strategies have been described in the literature, including complex clip constructs, parent vessel sacrifice with or without accompanying bypass, surgical excision and vessel reconstruction, and the use of interposition grafts along with aneurysm trapping. The authors of the article entitled, "The efficacy of bypass surgery using short interposition grafts for the treatment of intracranial complex aneurysm" in this issue of WORLD NEUROSURGERY relate their experience with the last of these surgical options.Successful use of the superficial temporal artery (STA) proximal to its bifurcation as a donor for a short radial artery (RA) or saphenous vein (SV) interposition graft has been previously described (2,6, 9,14,15). The rationale for the use of the proximal STA as a donor has been that the STA stump, through intraoperative flow measurements, has been shown to provide sufficient flow when the distal STA branches are unsuitable for bypass (2, 6).…”

“…Successful use of the superficial temporal artery (STA) proximal to its bifurcation as a donor for a short radial artery (RA) or saphenous vein (SV) interposition graft has been previously described (2,6, 9,14,15). The rationale for the use of the proximal STA as a donor has been that the STA stump, through intraoperative flow measurements, has been shown to provide sufficient flow when the distal STA branches are unsuitable for bypass (2, 6).…”