Skip Navigation LinksHome > September 2012 - Volume 71 - Issue 3 > Submandibular High-Flow Bypass in the Treatment of Skull Bas...
doi: 10.1227/NEU.0b013e318260fedd
Research-Human-Clinical Studies

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

Collapse Box


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

Copyright © by the Congress of Neurological Surgeons


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.