Occipital-posterior cerebral artery bypass via the occipital interhemispheric approach

Kazumata, Ken; Yokoyama, Yuka; Sugiyama, Taku; Asaoka, Katsuyuki

doi:10.4103/2152-7806.114975

Cited by 16 publications

(6 citation statements)

References 19 publications

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“…The direct anastomosis of the STA to an intracranial artery is considered a low-flow bypass (15-25 mL/ min) because of the relatively small diameter of the distal STA. 4,5,13,27 The benefits of this donor and similar use of the OA 28 include a single incision and anastomosis site, theoretically limiting the complication profile. High-flow grafts, such as the SV (70-140 mL/min) and RA (40-100 mL/min), provide flow replacement and can revascularize large territories or circumvent vessel sacrifice or occlusion.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Bypass Using the Descending Branch of the Lateral Circumflex Femoral Artery: A Case Series

Wolfswinkel

Rāviņa

Rennert

et al. 2022

Operative Neurosurgery

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BACKGROUND: When performing extracranial to intracranial (EC-IC) and intracranial to intracranial (IC-IC) bypass, the choice of donor vessel and interposition graft depends on several factors: vessel size and accessibility, desired blood flow augmentation, revascularization site anatomy, and pathology. The descending branch of the lateral circumflex femoral artery (DLCFA) is an attractive conduit for cerebrovascular bypass. OBJECTIVE: To present our institutional experience using DLCFA grafts for cerebral revascularization. METHODS: Retrospective review of perioperative data and outcomes for patients undergoing cerebrovascular bypass surgery using a DLCFA graft from 2016 to 2019. RESULTS: Twenty consecutive patients underwent EC-IC bypass using a DLCFA interposition graft. Bypass indications included 13 (65%) intracranial aneurysms, 4 (20%) medically refractory atherosclerotic large artery occlusions (internal carotid artery or middle cerebral artery), 2 (10%) internal carotid artery dissections, and 1 (5%) patient with moyamoya disease. Most commonly, a donor superior temporal artery was bypassed to a recipient middle cerebral artery (14 of 20; 70%). Two cases demonstrated graft spasm. Graft occlusion occurred in one patient and was asymptomatic. Perioperative bypass surgery-related ischemia occurred in 3 patients: 1 patient with insufficient bypass flow, 1 patient with graft stenosis because of an adventitial band, and 1 patient with focal status epilepticus in the bypassed territory resulting in cortical ischemia. One donor site hematoma occurred. The median (range) modified Rankin scale (mRS) score on follow-up was 1.5 (1-4) at 7.8 (1-27) months, with most patients achieving good functional outcomes (mRS ≤2). CONCLUSION: The DLCFA is a versatile graft for cerebral revascularization surgery, demonstrating good outcomes with minimal graft harvest site morbidity and an acceptable graft patency rate.

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Section: Discussionmentioning

confidence: 99%

Cerebral Bypass Using the Descending Branch of the Lateral Circumflex Femoral Artery: A Case Series

Wolfswinkel

Rāviņa

Rennert

et al. 2022

Operative Neurosurgery

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“…Vascular lesions of the UPC can be accessed through 3 main approaches: 1) the frontotemporal-orbitozygomatic craniotomy for lesions from the basilar apex to the proximal P 2A segment of the PCA and s 1 segment of the SCA; 2) the subtemporal approach for distal P 2A and P 2P segments of the PCA, and s 2 segment of the SCA; and 3) posterior interhemispheric approaches to lesions of the P 3 and P 4 segments of the PCA and s 4 segments of the SCA. 10,18,25,34,37 Current evidence seems to weigh in favor of endovascular therapy for lesions of the distal PCA (P 2 -P 4 ), and bypass has not been shown to be of much benefit in these segments. 9 In contrast, aneurysms of the proximal PCA and SCA are good candidates for surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Revascularization of the upper posterior circulation with the anterior temporal artery: an anatomical feasibility study

Meybodi

Lawton

Griswold

et al. 2018

Journal of Neurosurgery

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OBJECTIVE In various disease processes, including unclippable aneurysms, a bypass to the upper posterior circulation (UPC) including the superior cerebellar artery (SCA) and posterior cerebral artery (PCA) may be needed. Various revascularization options exist, but the role of intracranial (IC) donors has not been scrutinized. The objective of this study was to evaluate the anatomical feasibility of utilizing the anterior temporal artery (ATA) for revascularization of the UPC. METHODS ATA-SCA and ATA-PCA bypasses were performed on 14 cadaver specimens. After performing an orbitozygomatic craniotomy and opening the basal cisterns, the ATA was divided at the M-M junction and mobilized to the crural cistern to complete an end-to-side bypass to the SCA and PCA. The length of the recipient artery between the anastomosis and origin was measured. RESULTS Seventeen ATAs were found. Successful anastomosis was performed in 14 (82%) of the ATAs. The anastomosis point on the PCA was 14.2 mm from its origin on the basilar artery. The SCA anastomosis point was 10.1 mm from its origin. Three ATAs did not reach the UPC region due to a common opercular origin with the middle temporal artery. The ATA-SCA bypass was also applied to the management of an incompletely coiled SCA aneurysm. CONCLUSIONS The ATA is a promising IC donor for UPC revascularization. The ATA is exposed en route to the proximal SCA and PCA through the pterional-orbitozygomatic approach. Also, the end-to-side anastomosis provides an efficient and straightforward bypass without the need to harvest a graft or perform multiple or difficult anastomoses.

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“…Furthermore, it avoids injury to the temporobasal bridging veins encountered during conventional STA–superior cerebellar artery (SCA)/STA-PCA bypass through the subtemporal approach. 27 However, this approach does not permit control of the proximal PCA.…”

Section: Observationsmentioning

confidence: 99%

Selection of approach and bypass for fetal-type posterior cerebral artery aneurysm: illustrative cases

Kikuta

Yamaguchi

Ishikawa

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Unlike in aneurysms of the adult-type posterior cerebral artery (PCA), in aneurysms of the fetal-type PCA, parent artery occlusion (PAO) results in vascular insufficiency and major ischemic strokes. Preservation or reconstruction of fetal-type PCAs is necessary to prevent these complications. Furthermore, it is necessary to select an appropriate bypass method and approach for revascularization of the PCA. OBSERVATIONS The authors report 2 cases of aneurysms of fetal-type PCAs that were successfully treated with PAO with revascularization. A 38-year-old man with a large unruptured right PCA aneurysm at the postcommunicating (P2) segment underwent trapping with superficial temporal artery–PCA bypass via the anterior temporal and subtemporal approaches. In addition, a 45-year-old woman with a left PCA aneurysm at the quadrigeminal (P3)–cortical (P4) segments resulting in subarachnoid hemorrhage underwent proximal clipping of the P3 segment via the occipital interhemispheric approach with an occipital artery–PCA bypass. Although she had perforator infarction, major ischemic stroke was prevented, and aneurysm occlusion was accomplished in both cases. LESSONS Aneurysms of fetal-type PCAs pose a risk of ischemia due to PAO. The combined use of bypass and revascularization should be considered to prevent major ischemic stroke after occlusion of the fetal-type PCA. However, perforator infarction is a concern.

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Occipital-posterior cerebral artery bypass via the occipital interhemispheric approach

Cited by 16 publications

References 19 publications

Cerebral Bypass Using the Descending Branch of the Lateral Circumflex Femoral Artery: A Case Series

Cerebral Bypass Using the Descending Branch of the Lateral Circumflex Femoral Artery: A Case Series

Revascularization of the upper posterior circulation with the anterior temporal artery: an anatomical feasibility study

Selection of approach and bypass for fetal-type posterior cerebral artery aneurysm: illustrative cases

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