Operative neurosurgery (Hagerstown, Md.) · 2020
Three-Vessel Anastomosis for Direct Bihemispheric Cerebral Revascularization.
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Ravina Kristine, Yim Benjamin, Lam Jordan, Strickland Ben A, Carey Joseph N, Russin Jonathan J
Аннотация
BACKGROUND: In rare, complex cerebrovascular pathologies, patients may benefit from simultaneous revascularization of multiple arterial territories. Traditional strategies for these situations include the use of more than 1 interposition graft, multiple microvascular anastomoses, vessel reimplantations, and staged procedures.
OBJECTIVE: To improve upon traditional revascularization strategies by describing a novel 3-vessel microvascular anastomosis. This technique combines a side-to-side and an end-to-side anastomoses to facilitate simultaneous direct revascularization of 2 arterial territories in a single procedure, with a single donor vessel.
METHODS: We present an illustrative case of moyamoya angiopathy in which a 3-vessel anastomosis was performed in the interhemispheric fissure to simultaneously directly revascularize bilateral anterior cerebral artery (ACA) territories. A detailed step-by-step depiction of the anastomosis technique is provided. In the presented case, 3-vessel anastomosis was combined with a radial artery fascial flow-through free flap, allowing for an additional indirect revascularization.
RESULTS: Technical execution of the 3-vessel anastomosis was uncomplicated. The patency of the anastomosis providing direct bilateral ACA territory revascularization was demonstrated intra- and postoperatively.
CONCLUSION: With this report, we demonstrate technical feasibility of a novel 3-vessel anastomosis for direct 2 arterial territory revascularization This single-stage approach combines side-to-side and end-to-side techniques and has benefits over traditional revascularization techniques, as it is not deconstructive, requires only a single craniotomy and a single interposition graft, and does not require lengthy recipient artery dissection.
OBJECTIVE: To improve upon traditional revascularization strategies by describing a novel 3-vessel microvascular anastomosis. This technique combines a side-to-side and an end-to-side anastomoses to facilitate simultaneous direct revascularization of 2 arterial territories in a single procedure, with a single donor vessel.
METHODS: We present an illustrative case of moyamoya angiopathy in which a 3-vessel anastomosis was performed in the interhemispheric fissure to simultaneously directly revascularize bilateral anterior cerebral artery (ACA) territories. A detailed step-by-step depiction of the anastomosis technique is provided. In the presented case, 3-vessel anastomosis was combined with a radial artery fascial flow-through free flap, allowing for an additional indirect revascularization.
RESULTS: Technical execution of the 3-vessel anastomosis was uncomplicated. The patency of the anastomosis providing direct bilateral ACA territory revascularization was demonstrated intra- and postoperatively.
CONCLUSION: With this report, we demonstrate technical feasibility of a novel 3-vessel anastomosis for direct 2 arterial territory revascularization This single-stage approach combines side-to-side and end-to-side techniques and has benefits over traditional revascularization techniques, as it is not deconstructive, requires only a single craniotomy and a single interposition graft, and does not require lengthy recipient artery dissection.