Saphenous vein graft bypass of the cavernous internal carotid artery

1990 ◽  
Vol 72 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Chandra N. Sen ◽  
Hae Dong Jho
Keyword(s):  
Saphenous Vein ◽  
Vein Graft ◽  
Internal Carotid ◽  
Saphenous Vein Graft ◽  
Balloon Occlusion ◽  
Neurological Deficits ◽  
Content Type ◽  
Occlusion Test ◽  
Balloon Occlusion Test ◽  
Fine Print

✓ Saphenous vein graft reconstruction was performed from the petrous to the supraclinoid internal carotid artery (ICA) to replace the cavernous ICA in six patients during direct intracavernous operations. Four of these patients had intracavernous neoplasms with invasion of the ICA and two had intracavernous ICA aneurysms that could not be clipped or occluded with intraluminal balloons. All but one patient had evidence of poor collateral flow reserve in a balloon occlusion test of the ICA. The superficial temporal artery was not present in four patients, was minuscule in one, and was damaged during the initial dissection in another, making it unsuitable for superficial temporal-to-middle cerebral artery branch anastomosis. Blood flow within the graft could not be established intraoperatively in one patient (who had excellent collateral circulation) due to the small size of the vein (3 mm). In all others, the grafts were patent on follow-up arteriography and transcranial Doppler studies. Three patients who had severe reduction of cerebral blood flow during test occlusion of the ICA exhibited temporary hemispheric neurological deficits postoperatively; the deficits were related to the duration of temporary ICA occlusion. All three recovered completely without evidence of infarction on computerized tomography (CT). One patient who clinically could not tolerate the balloon occlusion test of the ICA also had temporary neurological deficits with good recovery but showed evidence of border-zone infarction on CT scans. The present role of saphenous vein graft bypass of the cavernous ICA is discussed.

Proximal intracranial internal carotid artery branches: prevalence and importance for balloon occlusion test

2005 ◽  
Vol 102 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Jason W. Allen ◽  
Anthony J. G. Alastra ◽  
Peter K. Nelson
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Balloon Occlusion ◽  
Content Type ◽  
Occlusion Test ◽  
Balloon Occlusion Test ◽  
The Right ◽  
Fine Print

Object. The aim of this study was to determine the prevalence of angiographically identifiable skull base arterial branches that potentially serve as collateral conduits during a balloon occlusion test (BOT) of the internal carotid artery (ICA). The authors posited that neurological deficits in patients who had previously tolerated the occlusion test may be attributable to an unrecognized collateral support through these channels (operant during proximal ICA BOT) when permanent ICA occlusion was performed more distally. Methods. In 481 cases (962 ICAs), cerebral angiograms obtained during routine Wada testing were retrospectively reviewed. Two hundred sixty-one patients had at least one angiographically identifiable ICA branch; 109 patients had two or more branches. A meningohypophyseal branch of the cavernous ICA was identified on the right side in 108 patients and on the left in 122. A vidian artery originated from the petrous portion of the ICA on the right side in 58 patients and on the left in 85. The inferolateral trunk revealed itself as a branch of the cavernous ICA on the right side in 17 patients and on the left in 33. A caroticotympanic artery arose from a left cavernous ICA. A persistent trigeminal artery was situated on the right side in two patients and on the left in three. More than half of the patients had angiographically identifiable and perhaps hemodynamically significant skull base branches of the ICA, and approximately one quarter had more than one identifiable branch. Conclusions. The authors recommend that patients be screened during angiography studies performed prior to BOT in branches of the proximal intracranial ICA and that the site of BOT be moved distally if such branches are identified.

By-pass extra-intracranici con graft di vena safena

2003 ◽  
Vol 16 (1) ◽  
pp. 165-167
Author(s):  
A. Santoro ◽  
E. Passacantilli ◽  
G.P. Cantore
Keyword(s):  
Collateral Circulation ◽  
Internal Carotid ◽  
Saphenous Vein Graft ◽  
Cerebral Aneurysms ◽  
Balloon Occlusion ◽  
Graft Occlusion ◽  
Parent Vessel ◽  
Occlusion Test ◽  
Balloon Occlusion Test ◽  
The Brain

Extracranial-intracranial by-pass is a valid technique for the treatment of uncoilable and unclippable cerebral aneurysms combined with the treatment of the parent vessel. This technique is utilized in giant and fusiform aneurysms of the internal carotid artery of the prepetrous, petrous, intracavernous and paraclinoid segments. The rationality of this method is to exclude the aneurysm by trapping of the parent vessel and to revascularize the brain through a saphenous vein graft. We report our experience with 51 brain revascularizations performed between 1985 and 2001 at our Institution, 46 of these were done for the treatment of uncoilable and unclippable cerebral aneurysms. In the first period, preoperative balloon occlusion test was performed to assess the type of anastomosis, then we performed the test intraoperatively by EEG. The incidence of graft occlusion was 12.9%. Our experience in this series suggests that the indications for cerebral revascularization should be widened even to include patients with adequate collateral circulation, particularly those who have a long life expentancy.

Cerebral revascularization to a main limb of the middle cerebral artery in the Sylvian fissure

1985 ◽  
Vol 63 (1) ◽  
pp. 21-29 ◽  
Author(s):  
Fernando G. Diaz ◽  
Felix Umansky ◽  
Bharat Mehta ◽  
Salvador Montoya ◽  
Manuel Dujovny ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Sylvian Fissure ◽  
External Carotid ◽  
Content Type ◽  
Fine Print

✓ Thirteen patients underwent an anastomosis of the superficial temporal artery (STA) or a saphenous vein graft to one of the secondary trunks of the middle cerebral artery (MCA). They included five patients with giant MCA trifurcation aneurysms, four patients in whom an earlier conventional STA-MCA anastomosis had become occluded, two patients who had stenosis of one of the secondary limbs of the MCA, and one patient who had a carotid-cavernous fistula. One patient had a saphenous vein graft from the common carotid artery to a secondary trunk of the MCA to bypass an occluded internal carotid artery and severely stenosed external carotid artery. The primary advantages of this procedure are that a large-caliber anastomosis to one of the secondary limbs of the MCA immediately restores flow into the MCA tree with a larger amount of vessel filling than with a standard cortical bypass, and large vessels can be used for the anastomosis. The disadvantages are that one of the secondary branches of the MCA must be occluded, the cerebral hemisphere around the Sylvian fissure must be retracted, a lumbar subarachnoid drain is needed, and the anastomosis must be performed deep within the Sylvian fissure. The procedure is a satisfactory alternative in cases in which a conventional STA-MCA anastomosis has either failed or would be less likely to succeed.

Saphenous vein graft bypass of the sigmoid sinus and jugular bulb during the removal of glomus jugulare tumors

1997 ◽  
Vol 86 (6) ◽  
pp. 1036-1041 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Fotios N. Tzortzidis ◽  
Ghassan K. Bejjani ◽  
David A. Schessel
Keyword(s):  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Tumor Resection ◽  
Jugular Bulb ◽  
Sigmoid Sinus ◽  
Content Type ◽  
Glomus Jugulare Tumor ◽  
Glomus Jugulare ◽  
Fine Print

✓ Glomus jugulare tumors always invade the jugular bulb and sigmoid sinus, making it difficult to resect these tumors totally without sacrificing the involved sinus. Although the sinus can be sacrificed safely in most patients, a few patients will have serious consequences. Reconstruction of the jugular bulb using a saphenous vein graft may enable tumor resection in these patients without complications. The authors describe two cases of saphenous vein grafting used to bypass the sigmoid sinus. The first case is that of a 61-year-old man with a glomus jugulare tumor that invaded the dominant sigmoid sinus, which was poorly collateralized. Temporary occlusion of the sinus during surgery caused a 15-mm Hg increase in intrasinus pressure, without brain swelling or changes in evoked potentials. A saphenous vein graft was used to bypass the sigmoid sinus and jugular bulb and to allow for total tumor removal. The patient had a good outcome. The second case is that of a 41-year-old man with a left glomus jugulare tumor and another smaller tumor on the opposite, dominant sinus. The left glomus jugulare tumor was resected via a two-stage procedure. A saphenous vein graft was used to reconstruct the left sigmoid sinus because of the presence of contralateral disease, with the potential for bilateral sigmoid sinus occlusion. An evaluation of the venous collateral circulation during jugular foramen surgery and the prevention of complications are also discussed.

X-ray Angiography Perfusion Analysis for the Balloon Occlusion Test of the Internal Carotid Artery

2015 ◽  
Vol 24 (7) ◽  
pp. 1506-1512 ◽  
Author(s):  
Katsunori Asai ◽  
Hirotoshi Imamura ◽  
Yohei Mineharu ◽  
Shoichi Tani ◽  
Hidemitsu Adachi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Balloon Occlusion ◽  
X Ray ◽  
Occlusion Test ◽  
Balloon Occlusion Test

Vertebral artery injury in C1–2 transarticular screw fixation: results of a survey of the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves

1998 ◽  
Vol 88 (4) ◽  
pp. 634-640 ◽  
Author(s):  
Neill M. Wright ◽  
Carl Lauryssen
Keyword(s):  
Vertebral Artery ◽  
Neurological Deficit ◽  
Peripheral Nerves ◽  
Balloon Occlusion ◽  
Neurological Deficits ◽  
Transarticular Screw ◽  
Content Type ◽  
Iatrogenic Complications ◽  
Number Of Patients ◽  
Fine Print

Object. The 847 active members of the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Section on Disorders of the Spine and Peripheral Nerves were surveyed to quantitate the risk of vertebral artery (VA) injury during C1–2 transarticular screw placement. Methods. This retrospective study elicited the number of patients treated with transarticular screws, the number of screws placed, the incidence of VA injury and subsequent neurological deficit, and the management of known or suspected VA injury. Two hundred thirteen (25.1%) of the 847 surgeons responded. One hundred one respondents (47.4%) had placed a total of 2492 C1–2 transarticular screws in 1318 patients. Thirty-one patients (2.4%) had known VA injuries and an additional 23 patients (1.7%) were suspected of having injuries. However, only two (3.7%) of the 54 patients with known or suspected VA injuries exhibited subsequent neurological deficits and only one (1.9%) died of bilateral VA injury. Other iatrogenic complications included dural tears, screw fractures, screw breakout, fusion failure, infection, and suboccipital numbness. Conclusions. Including both known and suspected cases, the risk of VA injury was 4.1% per patient or 2.2% per screw inserted. The risk of neurological deficit from VA injury was 0.2% per patient or 0.1% per screw, and the mortality rate was 0.1%. The choice of management of intraoperative VA injuries was evenly divided between placing the patient under observation and initiating immediate postoperative angiography with possible balloon occlusion.

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