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Simplified Azygos Anterior Cerebral Bypass: Y-Shaped Superficial Temporal Artery Interposition Graft From A2 With Double Reimplantation of Pericallosal Arteries: Technical Case Report

Mura, Jorge MD*,‡; Riquelme, Francisco MD*; Cuevas, José Luis MD*,‡; Luna, Felipe MD*,‡,§; Vizhñay, Pablo MD*,‡

doi: 10.1227/NEU.0b013e31827bc7c1
Technical Case Report

BACKGROUND AND IMPORTANCE: Trapping with distal revascularization is a therapeutic option for giant aneurysms that cannot be clipped or coiled. In skull base lesions such as meningiomas, arterial encasement is often present, requiring, in some cases, revascularization procedures: extracranial-to-intracranial bypass and more recently intracranial-to-intracranial techniques. These techniques are used only in exceptional cases of tumors in other localizations.

CLINICAL PRESENTATION: We report a case of a recurrent malignant frontal falx meningioma with encasement of both pericallosal arteries (PcaAs). During resection of the lesion, the left PcaA was sectioned and the right PcaA was occluded for manipulation and coagulation of the tumor. The occlusion was diagnosed with indocyanine green videoangiography. A Y-shaped superficial temporal artery graft was obtained in the right side, and the anterior cerebral artery circulation was reconstructed using an intracranial-to-intracranial bypass in the following fashion: right A2 to superficial temporal artery Y-shaped graft for both PcaAs. The patient’s postoperative period was uneventful with no deficit, and the computed tomography angiography showed the preservation of both PcaAs.

CONCLUSION: To the best of our knowledge, this microsurgical reconstruction of the PcaAs has not been performed before in a meningioma or a complex aneurysm case. We think the use of a superficial temporal artery as an in situ graft is more straightforward compared with other interposition grafts such as the radial artery graft or saphenous vein graft. The use of intracranial-to-intracranial techniques is the proper evolution of the use of classic extracranial-to-intracranial cerebral revascularization techniques.

ABBREVIATIONS: ACA, anterior cerebral artery

IC-IC, intracranial-to-intracranial

PcaA, pericallosal artery

STA, superficial temporal artery

*Cerebrovascular and Skull Base Surgery Team, Institute of Neurosurgery Asenjo, Santiago, Chile;

Department of Neurological Sciences, University of Chile, Santiago, Chile;

§Department of Biomedical Sciences, Faculty of Medicine, University of Valparaiso, Valparaiso, Chile

Correspondence: Jorge Mura, MD, FACS, Chief of Cerebrovascular and Skull Base Surgery, Institute of Neurosurgery Asenjo, Providencia, Santiago, Chile (PO Box 3717), Assistant Professor of Neurological Surgery, Department of Neurological Sciences, University of Chile, Santiago, Chile. E-mail:

Received September 07, 2012

Accepted October 10, 2012

Copyright © by the Congress of Neurological Surgeons