BACKGROUND: Cerebral bypass surgery remains an integral part of the treatment of complex skull base tumors and unclippable aneurysms.
OBJECTIVE: The authors retrospectively analyzed a single-surgeon experience using a high-flow submandibular–infratemporal saphenous vein graft bypass technique after carotid artery sacrifice in the resection of complex skull base tumors and carotid isolation in unclippable aneurysms.
METHODS: Data on indications, surgical technique, bypass patency, complications, and outcome were collected for patients treated with adjunctive submandibular high-flow bypass for skull base lesions.
RESULTS: Eleven patients (age range, 13-77 years) were treated for various skull base lesions: 4 patients were treated for skull base tumors with resection of the internal carotid artery (ICA), 6 were treated for aneurysms not amenable to clipping, and one was treated for invasive Mucor infection. With the use of a saphenous vein graft, a high-flow bypass was created from the high cervical ICA or external carotid artery to ICA or middle cerebral artery by means of a submandibular–infratemporal route. Postoperative angiography indicated bypass patency in 10 of 11 patients. There was no operative mortality. Follow-up of up to 12 years (mean, 56 months) was achieved.
CONCLUSION: Direct high-flow submandibular–infratemporal interpositional saphenous vein bypass graft is an effective and durable technique for the treatment of complex skull base lesions where ICA revascularization is indicated.
ABBREVIATIONS: CTA, computed tomography angiography
ECA, external carotid artery
ICA, internal carotid artery
MRA, magnetic resonance angiography
Department of Neurosurgery, University of Utah, Salt Lake City, Utah
Correspondence: William T. Couldwell, MD, PhD, Department of Neurosurgery, University of Utah, 175 N. Medical Dr East, Salt Lake City, UT 84132. E-mail: firstname.lastname@example.org
Received December 20, 2011
Accepted May 9, 2012