scholarly journals Universal External Carotid Artery to Proximal Middle Cerebral Artery Bypass With Interposed Radial Artery Graft Prior to Approaching Ruptured Blood Blister-Like Aneurysm of the Internal Carotid Artery

2009 ◽  
Vol 49 (11) ◽  
pp. 553-558 ◽  
Author(s):  
Tatsuya ISHIKAWA ◽  
Tatsushi MUTOH ◽  
Naoki NAKAYAMA ◽  
Hiroshi YASUDA ◽  
Mikio NOMURA ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Internal Carotid ◽  
Artery Bypass ◽  
External Carotid Artery ◽  
External Carotid ◽  
Radial Artery Graft ◽  
Artery Graft ◽  
Proximal Middle Cerebral Artery

Blister Aneurysms of the Internal Carotid Artery: Microsurgical Results and Management Strategy

Neurosurgery ◽  
2017 ◽  
Vol 80 (2) ◽  
pp. 235-247 ◽  
Author(s):  
Christopher M. Owen ◽  
Nicola Montemurro ◽  
Michael T. Lawton
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Treatment Strategy ◽  
Internal Carotid ◽  
Artery Bypass ◽  
External Carotid ◽  
Parent Artery ◽  
Intraoperative Rupture

Abstract BACKGROUND: Blister aneurysms of the supraclinoid internal carotid artery (ICA) are challenging lesions with high intraoperative rupture rates and significant morbidity. An optimal treatment strategy for these aneurysms has not been established. OBJECTIVE: To analyze treatment strategy, operative techniques, and outcomes in a consecutive 17-year series of ICA blister aneurysms treated microsurgically. METHODS: Seventeen patients underwent blister aneurysm treatment with direct clipping, bypass and trapping, or clip-reinforced wrapping. RESULTS: Twelve aneurysms (71%) were treated with direct surgical clipping. Three patients required bypass: 1 superficial temporal artery to middle cerebral artery bypass, 1 external carotid artery to middle cerebral artery bypass, and 1 ICA to middle cerebral artery bypass. One patient was treated with clip-reinforced wrapping. Initial treatment strategy was enacted 71% of the time. Intraoperative rupture occurred in 7 patients (41%), doubling the rate of a poor outcome (57% vs 30% for patients with and without intraoperative rupture, respectively). Severe vasospasm developed in 9 of 16 patients (56%). Twelve patients (65%) were improved or unchanged after treatment, and 10 patients (59%) had good outcomes (modified Rankin Scale scores of 1 or 2). CONCLUSION: ICA blister aneurysms can be cautiously explored and treated with direct clipping as the first-line technique in the majority of cases. Complete trapping of the parent artery with temporary clips and placing permanent clip blades along normal arterial walls enables clipping that avoids intraoperative aneurysm rupture. Trapping/bypass is used as the second-line treatment, maintaining a low threshold for bypass with extensive or friable pathology of the carotid wall and in patients with incomplete circles of Willis.

Creation of a Middle Communicating Artery With External Carotid Artery-Radial Artery Graft-M2 Middle Cerebral Artery Interpositional Bypass and M2 Middle Cerebral Artery-M2 Middle Cerebral Artery Reimplantation for a Recurrent Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Vol 20 (1) ◽  
pp. E44-E45
Author(s):  
Fabio A Frisoli ◽  
Joshua S Catapano ◽  
Dimitri Benner ◽  
Michael T Lawton
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Radial Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
External Carotid Artery ◽  
External Carotid ◽  
Radial Artery Graft ◽  
Lenticulostriate Arteries ◽  
Artery Graft

Abstract Dolichoectatic aneurysms of the middle cerebral artery (MCA) bifurcation pose unique treatment challenges.1 One treatment consists of an extracranial-intracranial (EC-IC) interpositional bypass and double-reimplantation of the M2 divisions.2-8 We present a variation of this construct in which an M2 MCA-M2 MCA end-to-side reimplantation was performed, creating a middle communicating artery (MCoA). The patient, a 61-yr-old woman, had previously undergone a “picket fence” clip reconstruction of an unruptured, giant left MCA bifurcation aneurysm in 2014.9 After the patient provided informed written consent for treatment, a 5-yr surveillance angiogram revealed substantial aneurysm regrowth opposite the clips.  A pterional craniotomy was performed, and the aneurysm was exposed through a transsylvian approach. Proximal external carotid artery-radial artery graft (ECA-RAG) anastomosis was performed to arterialize the graft. The distal RAG was anastomosed end-to-side to the temporal division of the M2 segment, and the vessel proximal to the bypass inflow was transected from the aneurysm. We repurposed this “dead-end” as an MCoA by end-to-side reimplantation onto a branch of the frontal M2 trunk. The superior trunk was then clip occluded at its origin at the aneurysm. The aneurysm could not be proximally occluded due to lenticulostriate arteries arising from the back of the bifurcation.  Postoperative angiography confirmed patency of the MCoA and its donor bypasses. The aneurysm no longer filled, and the lenticulostriate arteries were preserved. The patient was discharged on postoperative day 3 and made an excellent recovery (3-mo modified Rankin Scale [mRS] = 1). The MCoA is a novel construct that redistributed flow from the interpositional graft into the superior trunk, without the need for additional ischemia time while working with the inferior trunk. Used with permission from Barrow Neurological Institute.

Left External Carotid Artery to the Middle Cerebral Artery Bypass with Radial Artery Graft and Clip Reconstruction of a Large Middle Cerebral Artery Fusiform Aneurysm: 3-Dimensional Operative Video

2019 ◽  
Vol 17 (4) ◽  
pp. E159-E160 ◽  
Author(s):  
Chun-Yu Cheng ◽  
Zeeshan Qazi ◽  
Laligam N Sekhar
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Radial Artery ◽  
Cerebral Artery ◽  
Temporal Artery ◽  
External Carotid Artery ◽  
External Carotid ◽  
Fusiform Aneurysm ◽  
Radial Artery Graft ◽  
Artery Graft

Abstract This 16-yr-old boy presented with episodes of severe headaches, blurred vision, dizziness, and muffled hearing and was discovered to have a large fusiform aneurysm of the left middle cerebral artery (MCA), M1 segment, 20 × 12 mm in dimension. The lenticulostriate arteries were arising proximal and distal to the aneurysm, but the anterior temporal artery was arising from the aneurysm. The aneurysm culminated in the distal M1 segment, and M1 immediately branched into 3 M2 vessels, the lower one being the larger. Due to origin of the lenticulostriate arteries and the anterior temporal artery and patient's age, a bypass was preferred to a flow diversion stent.  He underwent left frontotemporal craniotomy and orbital osteotomy, left cervical external carotid artery exposure followed by radial artery graft extraction. The Sylvian fissure was opened and intracranial ICA was exposed for proximal control. The distal M2 vessels traced back toward the aneurysm. The aneurysm was not clippable and a bypass to the larger inferior M2 branch was performed followed by aneurysm trapping. The radial artery graft bypass was placed from the left external carotid artery to the M2 segment of left MCA, followed by clip reconstruction and occlusion of the MCA aneurysm with the preservation of the anterior temporal branch and the lenticulostriate vessels. The patient had no postoperative complications. At the follow-up, one month after surgery, he was doing well, and his angiogram demonstrated patency of the bypass.  This video shows the management of a complex fusiform M1 aneurysm with bypass and trapping.  Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

Use of “Bonnet” Bypass with Radial Artery Interposition Graft in a Patient with Recurrent Cranial Base Carcinoma: Technical Report of Two Cases and Review of the Literature

2005 ◽  
Vol 56 (suppl_1) ◽  
pp. ONS-E202-ONS-E202 ◽  
Author(s):  
Vivek R. Deshmukh ◽  
Randall W. Porter ◽  
Robert F. Spetzler
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Radial Artery ◽  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Cranial Base ◽  
Radial Artery Graft ◽  
Artery Graft

Abstract OBJECTIVE AND IMPORTANCE: Two patients with recurrent cranial base carcinomas involving the carotid artery received a “bonnet” bypass using the contralateral superficial temporal artery as the donor vessel because the ipsilateral common and external carotid arteries were unavailable. The radial artery was used as the graft. CLINICAL PRESENTATION: A 58-year-old man with ear pain and an enlarging mass involving the left cranial base and neck had undergone a right partial glossectomy and modified neck dissection followed by radiotherapy for squamous cell carcinoma. Recurrent carcinoma extensively involved the left internal carotid artery. A 46-year-old man with jaw pain and hoarseness had undergone multiple resections and radiation therapy for medullary thyroid carcinoma. Magnetic resonance imaging showed recurrent tumor on the right. INTERVENTION: Both patients underwent a pterional craniotomy. The supraclinoid internal carotid artery was exposed. The radial artery was harvested. The contralateral superficial temporal artery was dissected at its bifurcation into the frontal and parietal branches. The radial artery graft was anastomosed to the superficial temporal artery and a recipient ipsilateral branch of the middle cerebral artery. The internal carotid artery was clip-ligated. After surgery, both patients remained neurologically stable. Angiography confirmed that the bypasses were patent and that the middle cerebral artery territory filled. The patients’ carcinomas were resected aggressively. CONCLUSION: When aggressive resection of cranial base tumors is needed and the ipsilateral carotid artery is unavailable as a donor vessel, a “bonnet” bypass with carotid artery sacrifice may be performed. Compared with vein grafts, microsurgical anastomosis is easier and the patency rate is higher with a radial artery graft.

scholarly journals Middle cerebral artery revascularization: anatomical studies and considerations on the anastomosis site

1997 ◽  
Vol 55 (1) ◽  
pp. 16-23 ◽  
Author(s):  
Murilo S. Meneses ◽  
Ricardo Ramina ◽  
Andrea P. Jackowski ◽  
Ari A. Pedrozo ◽  
Robertson B. Pacheco ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Vascular Diseases ◽  
Anatomical Study ◽  
External Carotid Artery ◽  
External Carotid ◽  
Venous Graft

In the surgical management of skull base lesions and vascular diseases such as giant aneurysms, involvement of the internal carotid artery may require the resection or the occlusion of the vessel. The anastomosis of the external carotid artery and the middle cerebral artery with venous graft may be indicated to re-establish the blood flow. To determine the best suture site in the middle cerebral artery, an anatomical study was carried out. Fourteen cerebral hemispheres were analysed after the injection of red latex into the internal carotid artery. The superior and inferior trunk of the main division of the middle cerebral artery have more than 2 mm of diameter. They are superficial allowing an anastomosis using a venous graft. The superior trunk has a disadvantage, it gives rise to branches for the precentral and post-central giri. The anastomosis with the inferior trunk presents lower risk of neurological deficit even though the angular artery originates from it.

External Carotid Artery-to-Middle Cerebral Artery Bypass Using a Saphenous Vein Graft With 3-Vessel Anastomosis for the Treatment of a Large, Ruptured Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Kristine Ravina ◽  
Joshua Bakhsheshian ◽  
Joseph N Carey ◽  
Jonathan J Russin
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Saphenous Vein ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Artery Aneurysm ◽  
External Carotid Artery ◽  
External Carotid ◽  
Bifurcation Aneurysm

Abstract Cerebral revascularization is the treatment of choice for select complex intracranial aneurysms unamenable to traditional approaches.1 Complex middle cerebral artery (MCA) bifurcation aneurysms can include the origins of 1 or both M2 branches and may benefit from a revascularization strategy.2,3 A novel 3-vessel anastomosis technique combining side-to-side and end-to-side anastomoses, allowing for bihemispheric anterior cerebral artery revascularization, was recently reported.4  This 2-dimensional operative video presents the case of a 73-yr-old woman who presented as a Hunt-Hess grade 4 subarachnoid hemorrhage due to the rupture of a large right MCA bifurcation aneurysm. The aneurysm incorporated the origins of the frontal and temporal M2 branches and was deemed unfavorable for endovascular treatment. A strategy using a high-flow bypass from the external carotid artery to the MCA with a saphenous vein (SV) graft was planned to revascularize both M2 branches simultaneously, followed by clip-trapping of the aneurysm. Intraoperatively, the back walls of both M2 segments distal to the aneurysm were connected with a standard running suture, and the SV graft was then attached to the side-to-side construct in an end-to-side fashion. Catheter angiograms on postoperative days 1 and 6 demonstrated sustained patency of the anastomosis and good filling through the bypass. The patient's clinical course was complicated by vasospasm-related right MCA territory strokes, resulting in left-sided weakness, which significantly improved upon 3-mo follow-up with no new ischemia.  The patient consented for inclusion in a prospective Institutional Review Board (IRB)-approved database from which this IRB-approved retrospective report was created.

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