Revascularization for Complex Skull Base Tumors

We discuss revascularization techniques for complex skull base lesions utilizing high-flow arterial bypass. At present, the radial artery is the donor graft utilized in most circumstances at our institution. The knowledge of revascularization techniques is very important to achieve radical resection in lesions where arterial compromise is documented.

Skull base tumors - high-flow cerebral bypass - radial artery graft - microvascular anastomosis

REFERENCES

• 1 Greene K A, Anson J A, Spetzler R F. Giant serpentine middle cerebral artery aneurysm treated by extracranial-intracranial bypass. Case report.  J Neurosurg. 1993;  78 974-978
• 2 Kinugasa K, Maeshiro T, Sakurai M, Ohmoto T. Superficial temporal artery interposition graft after resection of bilateral anterior cerebral arteries.  J Neurosurg. 1993;  78 983-986
• 3 Martin N A. Arterial bypass for the treatment of giant and fusiform intracranial aneurysms.  Techniques in Neurosurgery. 1998;  4 153-178
• 4 Regli L, Piepgras D G, Hansen K K. Late patency of long saphenous vein bypass grafts to the anterior and posterior cerebral circulation.  J Neurosurg. 1995;  83 806-811
• 5 Sekhar L N, Chandler J P, Alyono D. Saphenous vein graft reconstruction of an unclippable giant basilar artery aneurysm performed with the patient under deep hipothermic circulatory arrest: technical case report.  Neurosurgery. 1998;  42 667-673
• 6 Sekhar L N, Wright D C, Olding M. Brain revascularization by saphenous vein and radial artery bypass grafting. In: Sekhar LN, de Oliveira E Cranial Microsurgery: Approaches and Techniques New York, NY; Thieme 1999: 581-600
• 7 Spetzler R F, Rhodes R S, Roski R A, Likavec M J. Subclavian to middle cerebral artery saphenous vein bypass graft.  J Neurosurg. 1980;  53 465-469
• 8 Fitzpatrick B C, Spetzler R F, Ballard J L, Zimmerman R S. Cervical-to-petrous internal carotid artery bypass procedure.  J Neurosurg. 1993;  79 138-141
• 8a Yasargil M G. Anastomosis between the superficial temporal artery and a branch of the middle cerebral artery. In: Yasargil MG Microsurgery Applied to Neurosurgery Stuttgart, Germany; Georg Thieme Verlag 1969 79: 105-115
• 8b Lougheed W M, Marshall B M, Hunter M, Michel E R, Sandwith-Smyth H. Common carotid to intracranial internal carotid bypass venous graft. Technical note.  J Neurosurg. 1971;  34 114-118
• 8c Spetzler R F, Rhodes R S, Roski R A, Likavec M J. Subclavian to middle cerebral artery saphenous vein bypass graft.  J Neurosurg. 1980;  53 465-469
• 8d Fisch U, Olding D, Senning A. Surgical therapy of internal carotid artery lesions of the skull base and temporal bone.  Otolaryngol Head Neck Surg. 1980;  88 548-554
• 8e Spetzler R F, Fukushima T, Martin N, Zabramski J M. Petrous carotid-to-intradural carotid saphenous vein graft for intracavernous giant aneurysm, tumor, and occlusive cerebrovascular disease.  J Neurosurg. 1990;  73 496-501
• 9 Serbinenko F A, Filatov J M, Spallone A, Tchurilov M V, Lazarev V A. Management of giant intracranial ICA aneurysms with combined extracranial-intracranial anastomosis and endovascular occlusion.  J Neurosurg. 1990;  73 57-63
• 10 Mura J, Tedeschi H, Wen H T, de Oliveira E. Technical aspects of high-flow long saphenous vein grafts for complex cerebral aneurysms: evolution to the prophylactic bypass. Presented or ally to the XXII Brazilian Congress of Neurosurgery. Rio de Janeiro, Brazil; 1998
• 11 Tedeschi H, Mura J, Ferreira M AT, Wen H T, De Oliveira E. Technical aspects of high flow long saphenous vein grafts for complex cerebral aneurysms.  J Bras Neurocirurg. 1999;  10 5-14
• 12 Sekhar L N, Duff M J, Kalavakonda C, Olding M. Cerebral revascularization using radial grafts for the treatment of complex intracranial aneurysms: techniques and outcomes for 17 patients.  Neurosurgery. 2001;  49 646-659
• 13 Sekhar L N, Kalavakonda C. Cerebral revascularization for aneurysms and tumors.  Neurosurgery. 2002;  50 321-331
• 14 Sundt Jr T M, Piepgras D G, Houser O W, Campbell J K. Interposition saphenous vein grafts for advanced occlusive disease and large aneurysms in the posterior circulation.  J Neurosurg. 1982;  56 205-215
• 15 Malisch T W, Guglielmi G, Viñuela F et al.. Unruptured aneurysms presenting with mass effect symptoms response to endovascular treatment with Guglielmi detachable coils. Part I. Symptoms of cranial nerve dysfunction.  J Neurosurg. 1998;  89 956-961
• 16 Guthikonda M, Guyot L L, Diaz F G. Future of extracranial-intracranial bypass.  Neurol Res. 2002;  24 S80-S83
• 17 Origitano T C, al-Mefty O, Leonetti J P, DeMonte F, Reichman H O. Vascular considerations and complications in cranial base surgery clinical study.  Neurosurgery. 1994;  35 351-362 , discussion 362-363
• 18 Sekhar L N, Patel S J. Permanent occlusion of the internal carotid artery during skull base and vascular surgery: is it really safe?.  Am J Otol. 1993;  14 421-422
• 19 Abdel-Aziz K, Froelich S, Dagnew E et al.. Large sphenoid wing meningioma involving the cavernous sinus: conservative surgical strategies for better functional outcomes.  Neurosurgery. 2004;  54 1375-1383 , discussion 1383-1384
• 20 George B, Anastasia-Ferrario C, Blanquet A, Kolb F. Cavernous sinus exanteration for invasive cranial base tumors.  Neurosurgery. 2003;  52 772-782
• 21 Sekhar L N, Bucur S D, Bank W O, Wright D C. Venous and arterial bypass grafts for difficult tumors, aneurysms and occlusive vascular lesions: evolution of operative management and improved results.  Neurosurgery. 1999;  44 1207-1224
• 22 Brisman M, Sen C, Catalano P. Results of surgery for head and neck tumors that involve the carotid artery at the skull base.  J Neurosurg. 1997;  86 787-792
• 23 Chazono H, Okamoto Y, Matsuzaki Z et al.. Extracranial-intracranial bypass for reconstruction of internal carotid artery in the management of head and neck cancer.  Ann Vasc Surg. 2003;  17 260-265
• 24 David C A, Zabramski J M, Spetzler R F. Reversed-flow saphenous vein grafts for cerebral revascularization. Technical note.  J Neurosurg. 1997;  87 795-797