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Lukyanchikov V.A.

Sklifosovsky Research Institute for Emergency Care;
Peoples’ Friendship University of Russia

Shatokhin T.A.

Evdokimov Moscow State University of Medicine and Dentistry

Gorozhanin V.A.

Burdenko Neurosurgical Center

Askerov E.D.

A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation

Smirnov A.A.

National Medical Research Center for Therapy and Preventive Medicine

Vaiman E.S.

Evdokimov Moscow State University of Medicine and Dentistry

Krylov V.V.

A.I. Evdokimov Moscow State Medical University;
N.V. Sklifosovsky Scientific and Research Institute of Emergency Medicine

Extra-intracranial bypass surgery using the orifice of maxillary artery in a patient with middle cerebral artery aneurysm. Case report and literature review

Authors:

Lukyanchikov V.A., Shatokhin T.A., Gorozhanin V.A., Askerov E.D., Smirnov A.A., Vaiman E.S., Krylov V.V.

More about the authors

Journal: Burdenko's Journal of Neurosurgery. 2022;86(5): 101‑111

DOI: 10.17116/neiro202286051101

Views: 2207

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To cite this article:

Lukyanchikov VA, Shatokhin TA, Gorozhanin VA, Askerov ED, Smirnov AA, Vaiman ES, Krylov VV. Extra-intracranial bypass surgery using the orifice of maxillary artery in a patient with middle cerebral artery aneurysm. Case report and literature review. Burdenko's Journal of Neurosurgery. 2022;86(5):101‑111. (In Russ., In Engl.)
https://doi.org/10.17116/neiro202286051101

Подписка 2025 (Burdenko's Journal of Neurosurgery)
 
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OBJECTIVE

To present the technique of extra-intracranial bypass surgery using the orifice of maxillary artery bypass, to evaluate the advantages and disadvantages of this and alternative revascularization options.

MATERIAL AND METHODS

Radial artery graft harvesting was performed at the 1st stage. Simultaneously, the second team of surgeons performed a combined (submandibular and anterior) access to the donor artery (mandibular segment of maxillary artery behind the ramus of the mandible). Craniotomy and mobilization of potential recipient arteries (M2-M3 segments of the middle cerebral artery) were performed at the 2nd stage. Distal anastomosis in end-to-side fashion was formed with M3 segment of the middle cerebral artery. At the 3rd stage, radial artery was passed through a subcutaneous tunnel in zygomatic region. The orifice of maxillary artery was resected together with distal external carotid artery (ECA) and orifice of superficial temporal artery. After transposition of ECA and orifice of maxillary artery, proximal end-to-end anastomosis was performed with radial artery. After that, the main surgical stage was performed, i.e. exclusion of M3 segment of the middle cerebral artery together with aneurysm.

RESULTS

Harvesting of mandibular segment of the maxillary artery as a donor vessel reduces the length of bypass graft to 12-14 cm since this branch is localized close to the skull base. You can also form optimal proximal end-to-end anastomosis for intracranial redirecting blood flow maxillary artery.

CONCLUSION

The described method makes it possible to form anastomosis with a short bypass graft and reduce the risk of thrombosis. This procedure is effective for cerebral bypass in patients with skull base tumors, complex aneurysms, and occlusive-stenotic lesions of carotid arteries.

Keywords:

anastomosis
vascular anastomosis
cerebral revascularization
maxillary artery
high-flow bypass
wide-lumen bypass
radial artery
radial artery graft
cerebral perfusion
external carotid artery

Authors:

Lukyanchikov V.A.

Sklifosovsky Research Institute for Emergency Care;
Peoples’ Friendship University of Russia

Shatokhin T.A.

Evdokimov Moscow State University of Medicine and Dentistry

Gorozhanin V.A.

Burdenko Neurosurgical Center

Askerov E.D.

A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation

Smirnov A.A.

National Medical Research Center for Therapy and Preventive Medicine

Vaiman E.S.

Evdokimov Moscow State University of Medicine and Dentistry

Krylov V.V.

A.I. Evdokimov Moscow State Medical University;
N.V. Sklifosovsky Scientific and Research Institute of Emergency Medicine

Received:

11.03.2022

Accepted:

19.08.2022

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