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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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Fig. 7.5t Postoperative anteroposterior angiographic
projection shows the radial artery graft from the ECA to
the recipient MCA. (Used with permission from Journal of
Neurosurgery .)
u v
Fig. 7.5u, v Anteroposterior and lateral angiographic views of the bypass formed with the radial artery graft.
Postoperatively, the patient had no neurological defi cits.
186 Color Atlas of Cerebral Revascularization
Case 7-6
Diagnosis: Recurrent MCA complex aneurysm
Bypass: ECA-to-MCA with radial artery graft and
subsequent spontaneous occlusion of
proximal MCA
Approach: Left frontotemporal
Fig. 7.6a Axial MR shows an MCA aneurysm that
hemorrhaged in a 7-month-old boy. The patient
was treated and made a good recovery.
High-Flow Cervical Carotid Artery–to–MCA Bypass 187
Fig. 7.6b Twelve years later the patient returned
with a new onset of headache. Anteroposterior
angiogram shows the old clips and a
multilobulated dissecting M2–M3 aneurysm.
Fig. 7.6c Lateral angiographic projection shows
the complex aneurysm and poor fi lling of some
of the branches of the MCA.
188 Color Atlas of Cerebral Revascularization
Fig. 7.6d Overview shows the craniotomy, neck incision, and exposed radial artery.
Fig. 7.6e Close-up of the exposed radial artery. Although this artery can be harvested endoscopically, we believe that
an open approach is less traumatic to the donor vessel.
Fig. 7.6f The catheter is tunneled subcutaneously from the neck incision to the cranial incision. The radial artery graft is
then passed through its lumen.
High-Flow Cervical Carotid Artery–to–MCA Bypass 189
Fig. 7.6g, h Anteroposterior and lateral left ICA
angiograms show that the MCA fl ow to the aneurysm
has been eliminated.
g
h
190 Color Atlas of Cerebral Revascularization
Fig. 7.6i Postoperative axial CT shows evidence of the old
hemorrhage that the patient suff ered as an infant but no
further damage.
Fig. 7.6j Postoperative lateral left CCA angiographic
injection shows the radial artery graft arising from the ECA
( arrow ).
High-Flow Cervical Carotid Artery–to–MCA Bypass 191
Fig. 7.6k Anteroposterior angiographic view shows
the fi lling of MCA territory via the graft.
Fig. 7.6l Early anterior oblique angiogram of the left ICA
injection shows complete occlusion of the MCA, from which the
original aneurysm had arisen. This spontaneous occlusion of
the MCA again emphasizes the importance of redirecting fl ow
around an aneurysm.
192 Color Atlas of Cerebral Revascularization
Fig. 7.6m Late phase angiogram of the ICA injection shows collateral
circulation to MCA branches that had failed to fi ll previously.
Fig. 7.6n Lateral angiogram of the ICA
injection shows the lack of fl ow in the
MCA territory.
High-Flow Cervical Carotid Artery–to–MCA Bypass 193
o
Fig. 7.6o, p Anterior oblique and lateral angiograms obtained 3 months after surgery show the anastomosis ( arrows )
and confi rm excellent fi lling of the MCA territory through the bypass.
p
194 Color Atlas of Cerebral Revascularization
Case 7-7
Diagnosis: Right ophthalmic artery giant aneu-
rysm
Bypass: Cervical ICA-to-MCA with saphenous vein
graft
Approach: Right pterional
Fig. 7.7a Anteroposterior angiographic
projection shows a giant calcifi ed
aneurysm with associated thrombosis.
The patient did not tolerate BTO.
Fig. 7.7b A saphenous vein has been anastomosed to a branch of the MCA in an end-to-side fashion.
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