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Anterior Temporal Artery-to-Anterior Cerebral Artery Bypass: Anatomic Feasibility of a Novel Intracranial-Intracranial Revascularization Technique.
World Neurosurg 2017; 99:667-673WN

Abstract

BACKGROUND

Complex aneurysms of the anterior cerebral artery (ACA) may require a bypass procedure as part of their surgical management. Most current bypass paradigms recommend technically demanding side-to-side anastomosis of pericallosal arteries or use of interposition grafts, which involve longer ischemia times. The purpose of this study is to assess the feasibility of an anterior temporal artery (ATA) to ACA end-to-side bypass.

METHODS

Fourteen cadaveric specimens (17 ATAs) were prepared for surgical simulation. The cisternal course of the ATA was freed from perforating branches and arachnoid. The M3-M4 junction of the ATA was cut, and the artery was mobilized to the interhemispheric fissure. The feasibility of ATA bypass to the precommunicating and postcommunicating ACA was assessed in relation to the cisternal length and branching pattern of the middle cerebral artery.

RESULTS

Successful anastomosis was feasible in 14 ATAs (82%). Three ATAs did not reach the ACA. These ATAs were branching distally and originated from the M3 (opercular) middle cerebral artery. In specimens where bypass was not feasible, the average cisternal length of the ATA was significantly shorter than the rest.

CONCLUSIONS

ATA-ACA bypass is anatomically feasible and may be a useful alternative to other revascularization techniques in selected patients. It is technically simpler than A3-A3 in situ bypass. ATA-ACA bypass can be performed through the same pterional exposure used for the ACA aneurysms, sparing the patient an additional interhemispheric approach, required for the A3-A3 anastomosis.

Authors+Show Affiliations

Department of Neurological Surgery, University of California, San Francisco, California, USA.Department of Neurological Surgery, University of California, San Francisco, California, USA.Department of Neurological Surgery, University of California, San Francisco, California, USA.Department of Neurological Surgery, University of California, San Francisco, California, USA.Department of Neurological Surgery, University of California, San Francisco, California, USA.Department of Neurological Surgery, University of California, San Francisco, California, USA.Department of Neurological Surgery, University of California, San Francisco, California, USA.Department of Neurological Surgery, University of California, San Francisco, California, USA. Electronic address: beneta@neurosurg.ucsf.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27965074

Citation

Meybodi, Ali Tayebi, et al. "Anterior Temporal Artery-to-Anterior Cerebral Artery Bypass: Anatomic Feasibility of a Novel Intracranial-Intracranial Revascularization Technique." World Neurosurgery, vol. 99, 2017, pp. 667-673.
Meybodi AT, Lawton MT, Griswold D, et al. Anterior Temporal Artery-to-Anterior Cerebral Artery Bypass: Anatomic Feasibility of a Novel Intracranial-Intracranial Revascularization Technique. World Neurosurg. 2017;99:667-673.
Meybodi, A. T., Lawton, M. T., Griswold, D., Mokhtari, P., Payman, A., Yousef, S., ... Benet, A. (2017). Anterior Temporal Artery-to-Anterior Cerebral Artery Bypass: Anatomic Feasibility of a Novel Intracranial-Intracranial Revascularization Technique. World Neurosurgery, 99, pp. 667-673. doi:10.1016/j.wneu.2016.12.007.
Meybodi AT, et al. Anterior Temporal Artery-to-Anterior Cerebral Artery Bypass: Anatomic Feasibility of a Novel Intracranial-Intracranial Revascularization Technique. World Neurosurg. 2017;99:667-673. PubMed PMID: 27965074.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anterior Temporal Artery-to-Anterior Cerebral Artery Bypass: Anatomic Feasibility of a Novel Intracranial-Intracranial Revascularization Technique. AU - Meybodi,Ali Tayebi, AU - Lawton,Michael T, AU - Griswold,Dylan, AU - Mokhtari,Pooneh, AU - Payman,Andre, AU - Yousef,Sonia, AU - Tabani,Halima, AU - Benet,Arnau, Y1 - 2016/12/10/ PY - 2016/10/21/received PY - 2016/12/01/revised PY - 2016/12/02/accepted PY - 2016/12/15/pubmed PY - 2017/9/19/medline PY - 2016/12/15/entrez KW - Anastomosis KW - Anterior cerebral artery KW - Anterior temporal artery KW - Cerebral revascularization KW - Complex intracranial aneurysms KW - Intracranial-intracranial bypass SP - 667 EP - 673 JF - World neurosurgery JO - World Neurosurg VL - 99 N2 - BACKGROUND: Complex aneurysms of the anterior cerebral artery (ACA) may require a bypass procedure as part of their surgical management. Most current bypass paradigms recommend technically demanding side-to-side anastomosis of pericallosal arteries or use of interposition grafts, which involve longer ischemia times. The purpose of this study is to assess the feasibility of an anterior temporal artery (ATA) to ACA end-to-side bypass. METHODS: Fourteen cadaveric specimens (17 ATAs) were prepared for surgical simulation. The cisternal course of the ATA was freed from perforating branches and arachnoid. The M3-M4 junction of the ATA was cut, and the artery was mobilized to the interhemispheric fissure. The feasibility of ATA bypass to the precommunicating and postcommunicating ACA was assessed in relation to the cisternal length and branching pattern of the middle cerebral artery. RESULTS: Successful anastomosis was feasible in 14 ATAs (82%). Three ATAs did not reach the ACA. These ATAs were branching distally and originated from the M3 (opercular) middle cerebral artery. In specimens where bypass was not feasible, the average cisternal length of the ATA was significantly shorter than the rest. CONCLUSIONS: ATA-ACA bypass is anatomically feasible and may be a useful alternative to other revascularization techniques in selected patients. It is technically simpler than A3-A3 in situ bypass. ATA-ACA bypass can be performed through the same pterional exposure used for the ACA aneurysms, sparing the patient an additional interhemispheric approach, required for the A3-A3 anastomosis. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/27965074/Anterior_Temporal_Artery_to_Anterior_Cerebral_Artery_Bypass:_Anatomic_Feasibility_of_a_Novel_Intracranial_Intracranial_Revascularization_Technique_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(16)31319-5 DB - PRIME DP - Unbound Medicine ER -