Identification of the optimal cortical target point for extracranial–intracranial bypass surgery in patients with hemodynamic cerebrovascular insufficiency

Abstract

The objective of this report is to describe a new approach to identify the optimal cortical target point for extracranial-intracranial (EC-IC) bypass surgery, to reliably find suitable recipient vessels for the anastomosis. Thirty consecutive patients (17 men and 13 women; mean age 54.6 +/- 11.79 years [+/- standard deviation]) with hemodynamic cerebrovascular insufficiency due to stenoocclusive arterial disease underwent EC-IC bypass surgery. The end of the Sylvian fissure was identified preoperatively using a specially designed template and external landmarks. At surgery, a 3-cm trephination was made, centered over the target point as determined by the template. The number, diameter, and length of the exposed cortical arteries were assessed using photographs and indocyanine green (ICG) angiograms. At least 1 recipient artery appropriate for anastomosis (>or= 1 mm) was found in every craniectomy. The mean number of suitable recipient arteries per craniotomy was 2.09 +/- 0.87, the mean diameter was 1.28 +/- 0.24 mm, and the mean length 10.83 +/- 4.87 mm. Bypass patency was confirmed by intraoperative ICG angiography, postoperative computed tomography angiography, and digital subtraction angiography, and reached 100%. Performing a 3-cm craniectomy over the described target point, reliably allows access to suitable recipient arteries for EC-IC bypass surgery.