Three-Vessel Anastomosis for Direct Bihemispheric Cerebral Revascularization. Issue 3 (26th December 2019)

• Record Type: Journal Article
• Authors: Ravina, Kristine; Yim, Benjamin; Lam, Jordan; Strickland, Ben A; Carey, Joseph N; Russin, Jonathan J
• Is Part Of: Operative neurosurgery. Volume 19:Issue 3(2020)
• Page Start: 313
• Page End: 318
• Publication Date: 2019-12-26
• Subjects: Bihemispheric revascularization -- Cerebral revascularization -- EC-IC bypass -- IC-IC bypass -- Moyamoya -- Three-vessel anastomosis; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1093/ons/opz401
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract: BACKGROUND: In rare, complex cerebrovascular pathologies, patients may benefit from simultaneous revascularization of multiple arterial territories. Traditional strategies for these situations include the use of more than 1 interposition graft, multiple microvascular anastomoses, vessel reimplantations, and staged procedures. OBJECTIVE: To improve upon traditional revascularization strategies by describing a novel 3-vessel microvascular anastomosis. This technique combines a side-to-side and an end-to-side anastomoses to facilitate simultaneous direct revascularization of 2 arterial territories in a single procedure, with a single donor vessel. METHODS: We present an illustrative case of moyamoya angiopathy in which a 3-vessel anastomosis was performed in the interhemispheric fissure to simultaneously directly revascularize bilateral anterior cerebral artery (ACA) territories. A detailed step-by-step depiction of the anastomosis technique is provided. In the presented case, 3-vessel anastomosis was combined with a radial artery fascial flow-through free flap, allowing for an additional indirect revascularization. RESULTS: Technical execution of the 3-vessel anastomosis was uncomplicated. The patency of the anastomosis providing direct bilateral ACA territory revascularization was demonstrated intra- and postoperatively. CONCLUSION: With this report, we demonstrate technical feasibility of a novel 3-vessel anastomosis for direct 2 arterial territory revascularization This single-stage approach combines side-to-side and end-to-side techniques and has benefits over traditional revascularization techniques, as it is not deconstructive, requires only a single craniotomy and a single interposition graft, and does not require lengthy recipient artery dissection.