The re-anastomosis end-to-end bypass technique: a comprehensive review of the technical characteristics and surgical experience

Wang, Long; Cai, Li; Qian, Hai; Tanikawa, Rokuya; Lawton, Michael T.; Shi, Xiaoyan

doi:10.1007/s10143-018-1036-z

Cited by 9 publications

(4 citation statements)

References 59 publications

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“…Reanastomosis of small arteries is executed optimally with oblique transections of the artery or using the fish-mouth technique to increase the anastomotic area of the reconstruction. 10 In this case, the large size of the V4 segment made these techniques unnecessary. The large caliber of the arterial ends facilitated the anastomosis.…”

Section: Discussionmentioning

confidence: 99%

The “Binder Ring” Bypass: Transection, Rerouting, and Reanastomosis as an Alternative to Macrovascular Decompression of a Dolichoectatic Vertebral Artery

Srinivasan

Labib

Furey

et al. 2022

Operative Neurosurgery

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BACKGROUND:In cases of extreme vertebrobasilar dolichoectasia, padding the cranial nerves (CNs) (microvascular decompression [MVD]) and clip-assisted sling transposition of the tortuous artery (macrovascular decompression [MaVD]) may be ineffective because the sling does not reduce the redundancy. Transposition may not decompress the nerves or may kink the artery. An alternative solution is needed.OBJECTIVE:To introduce the “binder ring” bypass as a novel solution to this unusual macrovascular compression problem.METHODS:The binder ring denotes the opening and closing of the offending vascular loop with standard bypass techniques with the artery transected, rerouted lateral to the CNs, and reanastomosed. An example case study is presented for a 72-year-old man whose severe vertebral artery tortuosity could not be relieved by MVD or MaVD. His pathology was exposed with an extended retrosigmoid craniotomy, the V4 segment was transected, the free ends were mobilized lateral to CN VII/VIII, and an end-to-end reanastomosis was performed with intraluminal suturing.RESULTS:The example binder ring bypass was patent angiographically, and the patient experienced immediate and lasting symptom relief without complications.CONCLUSION:The binder ring bypass applies standard bypass techniques to macrovascular compression but represents a significant escalation in technical challenges relative to traditional techniques. Patient tolerance to temporary arterial occlusion during reanastomosis depends on the location of the compressive arterial loop and the anatomy of collateral circulation. The binder ring bypass should be used as a last resort after medical therapy and MaVD techniques fail and performed only by neurosurgeons with advanced bypass skills.

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Section: Discussionmentioning

confidence: 99%

The “Binder Ring” Bypass: Transection, Rerouting, and Reanastomosis as an Alternative to Macrovascular Decompression of a Dolichoectatic Vertebral Artery

Srinivasan

Labib

Furey

et al. 2022

Operative Neurosurgery

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“…In the neurosurgical area this type of anastomosis is known with different names: end-to-end anastomosis or bypass, re-anastomosis, or reconstructive bypass [7], and has been utilized during the last four decades to treat complex aneurysms and skull base tumors [8]. Practicing this technique allows neurosurgery residents and junior neurosurgeons to experience a simulation of aneurysmal pathology excision or tumor resection, with the respective re-joining of the transected ends of the artery to restore blood flow, without needing a graft [7]. Generally, ETE anastomosis could be achieved in any cerebral artery, although the ideal location is one with a long arterial loop (e.g., MCA or PICA (postero-inferior cerebellar artery)) and fusiform aneurysm morphology.…”

Section: End-to-end Common Carotid Artery Anastomosismentioning

confidence: 99%

Specialized microsurgery simulation training models for the neurosurgery residents

Devia

Akelina

2022

ВХ

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Introduction. Microvascular training constitutes a foundational element of many highly specialized surgical fields. This manuscript describes my experience (D.A. Devia) as a neurosurgical resident during the advanced microsurgical course guided by the senior author (Ye. Akelina) at the Microsurgery Training and Research laboratory, Dept of Orthopedic Surgery, Columbia University Irving Medical Center.Methods. The technical aspects of advanced vascular exercises performed in the microsurgery laboratory are reviewed and presented, accompanied by figures of each exercise accomplished.Conclusions. Microsurgery vascular training is an important tool in every cerebrovascular surgeon, or any other specialty interested microvascular procedures. The experience and exercises demonstrated in this paper are extremely useful for microvascular practice and should be included in any advanced course around the world for every surgeon interested in this field.

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“…Recently, intracranial-to-intracranial bypass has been widely used for its simpler and less invasive characteristic. 18,30,31 At the same time, several potential shortcomings including anatomical constraints and technical demands should be considered. Besides, the frequent involvement of perforators, as in most cases in this study, may prohibit this technique from being indicated for proximal MCA aneurysms.…”

Section: Microsurgical Selection For Cmcaasmentioning

confidence: 99%

Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms

Wang

Cai

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe rapid innovation of the endovascular armamentarium results in a decreased number of indications for a classic surgical approach. However, a middle cerebral artery (MCA) aneurysm remains the best example of one for which results have favored microsurgery over endovascular intervention. In this study, the authors aimed to evaluate the experience and efficacy regarding surgical outcomes after applying internal maxillary artery (IMA) bypass for complex MCA aneurysms (CMCAAs).METHODSAll IMA bypasses performed between January 2010 and July 2018 in a single-center, single-surgeon practice were screened.RESULTSIn total, 12 patients (9 males, 3 females) with CMCAAs managed by high-flow IMA bypass were identified. The mean size of CMCAAs was 23.7 mm (range 10–37 mm), and the patients had a mean age of 31.7 years (range 14–56 years). The aneurysms were proximally occluded in 8 cases, completely trapped in 3 cases, and completely resected in 1 case. The radial artery was used as the graft vessel in all cases. At discharge, the graft patency rate was 83.3% (n = 10), and all aneurysms were completely eliminated (83.3%, n = 10) or greatly diminished (16.7%, n = 2) from the circulation. Postoperative ischemia was detected in 2 patients as a result of graft occlusion, and 1 patient presenting with subarachnoid hemorrhage achieved improved modified Rankin Scale scores compared to the preoperative status but retained some neurological deficits. Therefore, neurological assessment at discharge showed that 9 of the 12 patients experienced unremarkable outcomes. The mean interval time from bypass to angiographic and clinical follow-up was 28.7 months (range 2–74 months) and 53.1 months (range 19–82 months), respectively. Although 2 grafts remained occluded, all aneurysms were isolated from the circulation, and no patient had an unfavorable outcome.CONCLUSIONSThe satisfactory result in the present study demonstrated that IMA bypass is a promising method for the treatment of CMCAAs and should be maintained in the neurosurgical armamentarium. However, cases with intraoperative radical resection or inappropriate bypass recipient selection such as aneurysmal wall should be meticulously chosen with respect to the subtype of MCA aneurysm.

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The re-anastomosis end-to-end bypass technique: a comprehensive review of the technical characteristics and surgical experience

Cited by 9 publications

References 59 publications

The “Binder Ring” Bypass: Transection, Rerouting, and Reanastomosis as an Alternative to Macrovascular Decompression of a Dolichoectatic Vertebral Artery

The “Binder Ring” Bypass: Transection, Rerouting, and Reanastomosis as an Alternative to Macrovascular Decompression of a Dolichoectatic Vertebral Artery

Specialized microsurgery simulation training models for the neurosurgery residents

Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms

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