دورية أكاديمية
Double-Interposition Bypass: Technical Case Report of a Novel Intraoperative Bypass Salvage Technique
| العنوان: | Double-Interposition Bypass: Technical Case Report of a Novel Intraoperative Bypass Salvage Technique |
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| المؤلفون: | Graffeo, Christopher S, Srinivasan, Visish M, Winkler, Ethan A, Lawton, Michael T |
| المصدر: | Neurosurgery |
| بيانات النشر: | Barrow - St. Joseph's Scholarly Commons |
| سنة النشر: | 2023 |
| مصطلحات موضوعية: | Humans, Female, Cerebral Revascularization (methods), Intracranial Aneurysm (diagnostic imaging, surgery), Microsurgery (methods), Vascular Grafting, Neurosurgical Procedures (methods) |
| الوصف: | BACKGROUND AND IMPORTANCE: Complex cerebrovascular bypass operations may confer an increased risk of intraoperative complications, such as graft thrombosis. Novel techniques are needed to optimize the management of these challenging cases. CLINICAL PRESENTATION: A woman in her late 20s was incidentally diagnosed with a 1.5-cm basilar apex aneurysm, which grew to 3.5 cm over 2 years of active surveillance. Definitive treatment was then recommended with flow reversal and Hunterian ligation of the basilar trunk planned as a radial artery graft (RAG) bypass: M2 (S-Ec) RAG (E-Sc*) P2. Intraoperative graft thrombosis prompted multiple attempted salvage maneuvers; however, complete excision and repeat anastomosis were ultimately required. The procedure was completed using a novel double-interposition technique, with ligation of the index RAG approximately 1 cm proximal to the distal anastomosis (final bypass: M2 [S-Ec*] RAG [E-Ec*] RAG' [E-Sc] P2). These technical modifications yielded a less deep recipient site for the repeat bypass and an end-to-end anastomosis rather than an end-to-side anastomosis, collectively facilitating a more efficient and facile salvage. The patient recovered well from surgery, and flow reversal was successfully achieved within the aneurysm. CONCLUSION: Despite the increased risk of intraoperative thrombosis with complex cerebrovascular bypass operations, facility with salvage techniques can lead to technically and clinically excellent outcomes. We report the successful use of a novel fourth-generation double-interposition bypass that shortens the working distance and uses a more favorable anastomosis technique. This bypass may facilitate safe and efficient microsurgery in patients who require complete revision of an intracranial-intracranial construct. |
| نوع الوثيقة: | text |
| اللغة: | unknown |
| العلاقة: | https://scholar.barrowneuro.org/neurosurgery/1967Test; https://doi.org/10.1227/ons.0000000000000783Test |
| DOI: | 10.1227/ons.0000000000000783 |
| الإتاحة: | https://doi.org/10.1227/ons.0000000000000783Test https://scholar.barrowneuro.org/neurosurgery/1967Test |
| رقم الانضمام: | edsbas.A7538E0E |
| قاعدة البيانات: | BASE |
| DOI: | 10.1227/ons.0000000000000783 |
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