The V3 segment of the vertebral artery as a robust donor for intracranial-to-intracranial interpositional bypasses: technique and application in 5 patients

Meybodi, Ali Tayebi; Benet, Arnau; Lawton, Michael T.

doi:10.3171/2017.4.jns163195

Cited by 13 publications

(12 citation statements)

References 33 publications

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“…Rennert et al 18 demonstrated functional improvement in 3 patients who underwent superficial temporal artery to SCA bypass for vertebrobasilar artery insufficiency. Meybodi et al 19 and Gandhi et al 20 described alternative technical approaches to posterior circulation bypass using the V3 segment as a donor vessel and the common carotid artery as a recipient vessel, respectively. Britz et al 21 detailed the successful application of radial artery interposition grafting in 3 symptomatic patients with vertebrobasilar ischemia refractory to maximal medical management.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Arterial Bypass for Posterior Circulation Atherosclerosis: A Case Series

Farooq

Piper

Yeung

et al. 2022

Operative Neurosurgery

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BACKGROUND: Extracranial-intracranial bypass is an effective treatment option for moyamoya disease and in well-selected cases of anterior circulation intracranial atherosclerotic disease; however, the effectiveness of bypass is less evident in posterior circulation atherosclerosis. Updated surgical techniques and clinical guidelines necessitate modern appraisal of arterial bypass for symptomatic patients with posterior circulation atherosclerotic disease who are refractory to medical management. OBJECTIVE: To evaluate the complications, graft patency, and postoperative outcomes of arterial bypass for posterior circulation intracranial atherosclerotic disease. METHODS: Perioperative records of consecutive bypass patients were retrospectively evaluated to determine the clinical course and surgical outcomes. RESULTS: Arterial bypass was performed in 8 cases with a median age of 62 years. All 8 patients underwent direct bypass with an autologous occipital artery donor vessel. Recipient vessel selection varied on a case-by-case basis, with the superior cerebellar artery used in 4 cases, the posterior inferior cerebellar artery in 3 cases, and the anterior inferior cerebellar artery in 1 case. There were no significant intraoperative or postoperative complications. Postoperatively, all 8 patients displayed clinical improvement of their preoperative symptoms, with a significant decrease of 2.5 points on the modified Rankin Scale (P < .001). Postoperative imaging confirmed full graft patency in 7 patients and partial patency in 1 patient. CONCLUSION: Excellent postoperative outcomes and no major complications after posterior circulation arterial bypass for intracranial atherosclerotic disease highlight the utility of this intervention for the treatment of medically refractory or symptomatic posterior circulation intracranial atherosclerotic disease. Larger studies may be valuable to validate these findings.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Arterial Bypass for Posterior Circulation Atherosclerosis: A Case Series

Farooq

Piper

Yeung

et al. 2022

Operative Neurosurgery

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“…17,18 In this report, we used petrous ICA to revascularize UPC in practice for the first time, endowed this novel skull base bypass modality with the benefit of intracranialintracranial bypass 19 for the protection of graft conduits, and shortened the graft length to prevent turbulent flow and artery graft vasospasm to improve the patency rate and maintain the high pressure of blood flow with reduced graft resistance (Figure 3). 20,21 In particular, petrous ICA affords the most robust blood flow resource near the skull base because its diameter is approximately 5 mm, which is equivalent to the external carotid artery (ECA). 22 The Treatment of Basilar Trunk Aneurysms Deserves Utmost High-Flow Bypass High-Flow Bypass for Application of the Flow Reversal Strategy…”

Section: Discussion Skull Base Bypass Affords High-flow Capacitymentioning

confidence: 99%

“…31 This strategy also justified its efficacy in the treatment of dolichoectatic basilar trunk aneurysms. 21,[32][33][34][35] Nevertheless, it is difficult to predict successful conditions, whereas Kalani and Spetzler 10 reported that more than 1/3 of cases exhibited aneurysm enlargement in their series. In our experience, this unfavorable result rests on the employment of superficial temporal artery bypass to either the PCA or superior cerebellar artery (SCA).…”

Section: Discussion Skull Base Bypass Affords High-flow Capacitymentioning

confidence: 99%

Petrous Carotid to Upper Posterior Circulation Bypass for the Treatment of Basilar Trunk Aneurysm: A Novel High-Flow Intracranial–Intracranial Skull Base Bypass for Posterior Circulation

Wang

Tong

Liu

et al. 2022

Operative Neurosurgery

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BACKGROUND:Basilar trunk aneurysms are the most surgically challenging, and the spectrum covers small fusiform to dolichoectatic aneurysms and may lead to rupture, brain ischemia, or direct brainstem compression. The current strategy remains cerebral revascularization coupled with aneurysm trapping. Available bypass options for upper posterior circulation (UPC) are based on (1) different flow volumes from diverse blood supplies and (2) distinct modulation purposes for cerebral revascularization; however, the potential compromise of eloquent perforators of the basilar trunk and the occurrence of fatal brainstem infarcts remain unacceptable.OBJECTIVE:To innovate a high-flow intracranial–intracranial skull base bypass for posterior circulation to afford robust retrograde flow and shorten the graft length.METHODS:We retrospectively reviewed our experience in the treatment of a patient with basilar trunk aneurysm and reported a novel bypass alternative supplied by petrous internal carotid artery to augment blood flow to the UPC by a pretemporal approach.RESULTS:The postoperative course was uneventful, and there was no pons or midbrain ischemia or other complications. Postoperative computed tomography angiogram revealed the patency of bypass. There was no further development or rerupture observed during follow-up.CONCLUSION:Petrous internal carotid artery as a donor site is a reliable bypass modality for UPC. This approach provides the utmost retrograde flow to alleviate the development of dissecting aneurysms, preserves eloquent perforators of the basilar trunk, maintains bypass patency, and shortens the graft course. Therefore, this novel therapeutic alternative could be beneficial for improving the prognosis of basilar trunk aneurysms.

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“…30 This triangle (usually exposed via a farlateral approach) is used for the surgical exposure of the suboccipital (V 3 ) segment of the VA when the V 3 segment is being considered as a donor or recipient for a bypass procedure. 37,46 In contrast, the subatlantic triangle is located inferolateral to the suboccipital triangle (i.e., inferior and lateral to C-1 and inferior oblique muscle). Surgical exploration of this triangle leads us to the most superior portion of the V 2 VA (atlantoaxial VA), which could be used as a donor or recipient in various craniovertebral junction of posterior fossa pathologies (Table 1).…”

Section: Subatlantic Triangle Versus Suboccipital Trianglementioning

confidence: 99%

The subatlantic triangle: gateway to early localization of the atlantoaxial vertebral artery

Meybodi¹,

Gandhi²,

Preul³

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEExposure of the vertebral artery (VA) between C-1 and C-2 vertebrae (atlantoaxial VA) may be necessary in a variety of pathologies of the craniovertebral junction. Current methods to expose this segment of the VA entail sharp dissection of muscles close to the internal jugular vein and the spinal accessory nerve. The present study assesses the technique of exposing the atlantoaxial VA through a newly defined muscular triangle at the craniovertebral junction.METHODSFive cadaveric heads were prepared for surgical simulation in prone position, turned 30°–45° toward the side of exposure. The atlantoaxial VA was exposed through the subatlantic triangle after reflecting the sternocleidomastoid and splenius capitis muscles inferiorly. The subatlantic triangle was formed by 3 groups of muscles: 1) the levator scapulae and splenius cervicis muscles inferiorly and laterally, 2) the longissimus capitis muscle inferiorly and medially, and 3) the inferior oblique capitis superiorly. The lengths of the VA exposed through the triangle before and after unroofing the C-2 transverse foramen were measured.RESULTSThe subatlantic triangle consistently provided access to the whole length of atlantoaxial VA. The average length of the VA exposed via the subatlantic triangle was 19.5 mm. This average increased to 31.5 mm after the VA was released at the C-2 transverse foramen.CONCLUSIONSThe subatlantic triangle provides a simple and straightforward pathway to expose the atlantoaxial VA. The proposed method may be useful during posterior approaches to the craniovertebral junction should early exposure and control of the atlantoaxial VA become necessary.

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The V3 segment of the vertebral artery as a robust donor for intracranial-to-intracranial interpositional bypasses: technique and application in 5 patients

Cited by 13 publications

References 33 publications

Outcomes of Arterial Bypass for Posterior Circulation Atherosclerosis: A Case Series

Outcomes of Arterial Bypass for Posterior Circulation Atherosclerosis: A Case Series

Petrous Carotid to Upper Posterior Circulation Bypass for the Treatment of Basilar Trunk Aneurysm: A Novel High-Flow Intracranial–Intracranial Skull Base Bypass for Posterior Circulation

The subatlantic triangle: gateway to early localization of the atlantoaxial vertebral artery

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