Document Detail


The plastic surgeon's role in extracranial-to-intracranial bypass using a reverse great saphenous vein graft.
MedLine Citation:
PMID:  19182608     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Extracranial-to-intracranial bypass is used for flow replacement and diversion that prevent the serious complications associated with sudden ligation of the middle cerebral artery for treatment of complex tumors or aneurysms. Extracranial-to-intracranial bypass is a demanding procedure that requires experience in advanced microsurgical techniques. In this article, the authors review the first report of an extracranial-to-intracranial bypass performed by a plastic surgeon with emphasis on indications for microsurgical involvement in neurosurgical practice and on description of the surgical technique.
METHODS: Between April of 2004 and October of 2006, three extracranial-to-intracranial bypass cases were performed including one for a complex aneurysm rupture and two for resections of cranial base tumors. In every case, the intracranial approach was used by the neurosurgeon. The bypass was performed by interposing a reverse great saphenous vein graft between the superficial temporal artery, in end-to-end anastomosis, and the second segment of the middle cerebral artery, in end-to-side anastomosis.
RESULTS: In each case, postoperative cerebral angiography demonstrated complete patency of the extracranial-to-intracranial bypass. Neither of the two surviving patients at a mean follow-up of 13 months had deterioration of neurologic function, postoperative stroke, or surgery-related death. One of the patients was dead before the 6-month follow-up.
CONCLUSIONS: The reverse great saphenous vein graft is a good option for extracranial-to-intracranial bypass, with the advantages of high-flow graft, wide lumen, adequate length, easy harvest, and minimal donor-site morbidity. The plastic surgery/neurosurgery alliance allows scope for improved outcomes in complex neurosurgical cases and continues to push the frontiers of reconstructive microsurgery.
Authors:
Christina Bernier; Yung-Hsin Hsu; Rozina Ali; Ming-Huei Cheng
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  123     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-02     Completed Date:  2009-03-02     Revised Date:  2011-02-16    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  517-23; discussion 524     Citation Subset:  AIM; IM    
Affiliation:
Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anastomosis, Surgical / methods
Aneurysm, Ruptured / surgery*
Brain Ischemia / prevention & control,  surgery
Cerebral Angiography
Humans
Intracranial Aneurysm / radiography,  surgery*
Male
Middle Aged
Middle Cerebral Artery / radiography,  surgery
Neurosurgical Procedures / methods*
Saphenous Vein / transplantation*
Skull Base Neoplasms / radiography,  surgery*
Surgery, Plastic / methods*
Temporal Arteries / radiography,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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