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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3617_Библиотеки_им_академика_М_И_Перельмана
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MCA-to-MCA Bypass 105
Fig. 4.1h Postoperative anteroposterior angiogram
confi rms patency of the reanastomosed branch (arrow).
An incidental ophthalmic artery aneurysm has been
obliterated with a clip.
106 Color Atlas of Cerebral Revascularization
Case 4-2
Diagnosis: Right MCA aneurysm
Bypass: M2-to-M2 side-to-side
Approach: Right orbitozygomatic
Fig. 4.2a Three-dimensional rotational angiography shows a
broad-necked aneurysm of the right MCA.
Fig. 4.2b An attempt to apply an aneurysm clip occludes an M2 branch.
MCA-to-MCA Bypass 107
Fig. 4.2c During adjustment, a small tear opens on the shoulder of the M2 branch.
Fig. 4.2d The M2 branches are apposed side to side in the sylvian fi ssure.
108 Color Atlas of Cerebral Revascularization
Fig. 4.2e Temporary clips are applied so that the vessels rotate apart slightly. The vessels are opened.
Fig. 4.2f The back wall is sewn with running suture.
Fig. 4.2g The front wall is sewn with running stitches using the same suture.
MCA-to-MCA Bypass 109
Fig. 4.2h ICG angiography shows brisk fi lling of all vessels
through the bypass.
Fig. 4.2i Postoperative three-dimensional reconstructed CT
angiogram shows the completed bypass.
110 Color Atlas of Cerebral Revascularization
Case 4-3
Diagnosis: Fusiform MCA aneurysm
Bypass: M2-to-M3 interposition radial artery graft
Approach: Right pterional
Fig. 4.3a Noncontrast CT scan of the head shows a small
amount of blood in the right sylvian fi ssure.
Fig. 4.3b Right ICA angiogram shows a fusiform MCA
aneurysm.
MCA-to-MCA Bypass 111
Fig. 4.3c Three-dimensional
reconstructed CT shows the involvement
of the middle branch of the MCA
trifurcation.
Fig. 4.3d A right pterional craniotomy is performed to expose the aneurysm in the sylvian fi ssure.
112 Color Atlas of Cerebral Revascularization
Fig. 4.3e A small segment of the aff ected branch is found to be normal.
Fig. 4.3f A radial artery graft is prepared.
Fig. 4.3g Temporary clips are applied and the aneurysm is collapsed.
MCA-to-MCA Bypass 113
Fig. 4.3h The distal end of the aneurysm, where the M3 is normal, is cut and the aneurysm is excised.
Fig. 4.3i The radial artery graft is sutured to the fi shmouthed end of the distal M3 stump.
Fig. 4.3j The running suture is cinched tight.
114 Color Atlas of Cerebral Revascularization
Fig. 4.3k The proximal end of the radial artery graft is anastomosed to the M2 stump with running sutures.
Fig. 4.3l The interposition radial artery graft is seen between the two anastomoses.
Fig. 4.3m ICG angiogram confi rms blood
fl ow through the radial artery graft. The
central defect in the image is caused by
overlying fat.
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