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Submandibular High-Flow Bypass in the Treatment of Skull Base Lesions: An Analysis of Long-term Outcome

Couldwell, William T. MD, PhD; Taussky, Philipp MD; Sivakumar, Walavan MD

doi: 10.1227/NEU.0b013e318260fedd
Research-Human-Clinical Studies

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:

Received December 20, 2011

Accepted May 9, 2012

Copyright © by the Congress of Neurological Surgeons