Submandibular-Infratemporal Interpositional Carotid Artery Bypass for Cranial Base Tumors and Giant Aneurysms

Abstract

Cerebral revascularization is an important strategy in the surgical management of some complex cranial base tumors and unclippable aneurysms. A high-flow bypass may be necessary in planned carotid occlusion or sacrifice. The cervical-to-supraclinoid internal carotid artery bypass or cervical carotid-to-middle cerebral artery bypass are useful procedures to bypass lesions at the base of the cranium. We describe technical modifications of the submandibular-infratemporal interpositional saphenous vein (or radial artery) graft bypass technique specifically designed to avoid removal of the zygoma. The saphenous vein or radial artery interpositional graft is tunneled through a burr hole created in the floor of the middle fossa via a submandibular-infratemporal route avoiding removal of zygoma and attachments of the masseter or temporalis muscles. The technique is demonstrated in one patient with removal of a malignant cavernous sinus tumor and in another patient with an unclippable giant carotid bifurcation aneurysm. The advantages of this approach include preservation of the facial anatomy and creation of a short and safe route for passage of the saphenous vein or radial artery graft.