Radiologic evaluation of extracranial to Sylvian middle cerebral artery bypass

Modèle animal d'entraînement à l'anastomose temporosylvienne

BACKGROUND AND PURPOSE

Microsurgical training in neurosurgery is essential, the aim being to practise surgery with the microscope and to learn vascular and nervous anastomosis techniques. The objective of this project was to create a model simulating the human anatomy and surgical conditions.

TECHNIQUE

Rats were operated on using a plaster model mimicking a human hemicranium. The technique performed was an end to side anastomosis of the distal free end of the left carotid to the right carotid arteriotomy, using eight interrupted 10/0 sutures, at a depth of 5 cm. Early and delayed patency tests were performed.

DISCUSSION

Various models and techniques for training to microsurgical arterial anastomosis are described in the literature. The determining factor is the skill of the operator, which is in turn dependent on the level of training. This model allows the surgeon to gain significant technical experience with the EC-IC bypass, which is applicable to human neurosurgical practice and is indispensable for the prospective neurovascular surgeon.

Multi-slice CT angiography in evaluation of extracranial-intracranial bypass

Multi-slice CT (MSCT) scanners provided significant improvement in vascular applications. In this study, our purpose was to determine the clinical utility of MSCTA in evaluation of extracranial-intracranial (EC-IC) bypass patency. Eleven (4 men and 7 women; mean age, 46 years; age range, 19-68 years) consecutive patients who underwent MSCTA and DSA after EC-IC bypass surgery were evaluated retrospectively. All patients underwent DSA within 3 weeks of MSCTA. The indications for EC-IC bypass were severe stenosis or occlusion of intracranial arteries in seven patients and therapeutic occlusion of intracranial artery for unclippable giant aneurysm in four patients. Ten patients underwent superficial temporal artery (STA)-middle cerebral artery (MCA) bypass and one patient underwent occipital artery-posterior cerebral artery (PCA) bypass. Eight STA-MCA bypasses in six patients were patent on MSCTA which were confirmed on DSA. Two STA-MCA bypasses and one occipital artery-posterior cerebral artery (PCA) bypass were occluded in three patients on MSCTA and DSA. In one patient, minimal stenosis of the STA-MCA bypass was identified on MSCTA and DSA. In 1 patient, STA-MCA bypass was not well seen on MSCTA and suspected for occlusion. DSA identified the occlusion of bypass on this patient. MSCTA seems to be a very promising noninvasive technique in evaluation of EC-IC bypass.