J Neurol Surg B Skull Base 2014; 75(06): 421-426
DOI: 10.1055/s-0034-1383857
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Use of Superior Thyroid Artery as a Donor Vessel in Extracranial-Intracranial Revascularization Procedures: A Novel Technique

Jorge Mura
1   Department of Cerebrovascular and Skull Base Surgery, Institute of Neurosurgery Asenjo, Providencia, Santiago, Chile
2   Department of Neurological Sciences, School of Medicine, University of Chile, Santiago, Chile
,
José Luis Cuevas
1   Department of Cerebrovascular and Skull Base Surgery, Institute of Neurosurgery Asenjo, Providencia, Santiago, Chile
2   Department of Neurological Sciences, School of Medicine, University of Chile, Santiago, Chile
,
Francisco Riquelme
1   Department of Cerebrovascular and Skull Base Surgery, Institute of Neurosurgery Asenjo, Providencia, Santiago, Chile
,
Esteban Torche
1   Department of Cerebrovascular and Skull Base Surgery, Institute of Neurosurgery Asenjo, Providencia, Santiago, Chile
,
Rodrigo Julio
3   Department of Vascular Surgery, Salvador Hospital, Santiago, Chile
,
Gustavo Rassier Isolan
4   Department of Cerebrovascular and Skull Base Surgery, Sustainable Health NGO, São Leopoldo, RS, Brazil
5   Department of Cerebrovascular and Skull Base Surgery, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
6   Department of Cerebrovascular and Skull Base Surgery, Skull Base and Brain Tumor Center, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
› Author Affiliations
Further Information

Publication History

18 February 2014

06 May 2014

Publication Date:
06 August 2014 (online)

Abstract

Objective To describe the use of the superior thyroid artery as a donor vessel in extracranial-intracranial (EC-IC) revascularization when a “low-flow” bypass is required and the superficial temporal artery is not available.

Design Case report.

Setting University hospital.

Participants Four cases.

Main Outcome Measures Postoperative course after EC-IC bypass surgery.

Results In case 1, the parent vessel was occluded postoperatively. The radial bypass was sufficient to replace the internal carotid artery (ICA) flow, and a prophylactic was turned into a definitive bypass. In case 2, the superior thyroid artery was used because the radial artery was not long enough to reach the external carotid artery. The recipient vessel was modified from the middle cerebral artery to the ophthalmic segment of the ICA. In case 3, the graft was occluded after surgery because of carotid artery reconstruction. In case 4, after surgery/radiotherapy for meningioma, the patient developed wound dehiscence and was reoperated for bypass occlusion. The graft was weak and bled intraoperatively, without infarction. The three first patients are intact, and the fourth remains disabled (Glasgow Outcome Scale: 3; Rankin Scale: 5).

Conclusion The superior thyroid artery was adequate for proximal anastomosis in EC-IC procedures in the situations described.

 
  • References

  • 1 Ausman JI, Diaz FG, Sadasivan B, Gonzeles-Portillo Jr M, Malik GM, Deopujari CE. Giant intracranial aneurysm surgery: the role of microvascular reconstruction. Surg Neurol 1990; 34 (1) 8-15
  • 2 Awad IA, Spetzler RF. Extracranial-intracranial bypass surgery: a critical analysis in light of the International Cooperative Study. Neurosurgery 1986; 19 (4) 655-664
  • 3 Karasawa J, Kikuchi H, Furuse S, Kawamura J, Sakaki T. Treatment of moyamoya disease with STA-MCA anastomosis. J Neurosurg 1978; 49 (5) 679-688
  • 4 Lawton MT, Hamilton MG, Morcos JJ, Spetzler RF. Revascularization and aneurysm surgery: current techniques, indications, and outcome. Neurosurgery 1996; 38 (1) 83-92 ; discussion 92–94
  • 5 Nussbaum ES, Erickson DL. Extracranial-intracranial bypass for ischemic cerebrovascular disease refractory to maximal medical therapy. Neurosurgery 2000; 46 (1) 37-42 ; discussion 42–43
  • 6 Surdell DL, Hage ZA, Eddleman CS, Gupta DK, Bendok BR, Batjer HH. Revascularization for complex intracranial aneurysms. Neurosurg Focus 2008; 24 (2) E21
  • 7 Mura J, Malago-Tavares W, Figueiredo E. Basic aspects of high-flow extracranial-intracranial bypass: Part I. Contemp Neurosurg 2010; 32: 1-4
  • 8 Ashley WW, Amin-Hanjani S, Alaraj A, Shin JH, Charbel FT. Flow-assisted surgical cerebral revascularization. Neurosurg Focus 2008; 24 (2) E20
  • 9 Krayenbühl N, Isolan GR, Hafez A, Yaşargil MG. The relationship of the fronto-temporal branches of the facial nerve to the fascias of the temporal region: a literature review applied to practical anatomical dissection. Neurosurg Rev 2007; 30 (1) 8-15 ; discussion 15
  • 10 Mura J, Rojas-Zalazar D, de Oliveira E. Revascularization for complex skull base tumors. Skull Base 2005; 15 (1) 63-70
  • 11 Abdo M, Krayenbuhl N, Isolan GR, Krisht AF. Cerebral revascularization: Part I: Indications and evaluation. Contemp Neurosurg 2006; 28: 1-7
  • 12 Krayenbuhl n, abdo m, isolan gr, krisht af. Cerebral revascularization: part ii: techniques. Contemp Neurosurg 2006; 28: 1-5