Endoscopic radial artery harvesting for U-clip EC-IC bypass in the treatment of a giant petrous internal carotid artery aneurysm: technical case report

Minim Invasive Neurosurg. 2009 Aug;52(4):186-9. doi: 10.1055/s-0028-1105901. Epub 2009 Oct 16.

Abstract

Introduction: High-flow extracranial-intracranial (EC-IC) bypass and aneurysm trapping constitutes a well-known surgical solution for internal carotid artery (ICA) aneurysms that are not amenable to clip ligation or endovascular therapy. The advantages of the radial artery (RA) as a conduit for myocardial revascularization have become widely accepted, with a better patency rate than that of the saphenous vein.

Case report: A 66-year-old woman was found to harbour a right giant, partially thrombosed aneurysm of the intrapetrous segment of the internal carotid artery. Endoscopic harvesting of the RA was achieved combining a resterilizable retractor and a vessel sealing system. After neck dissection, the main trunk of the middle cerebral artery (MCA), its branches, and part of the aneurysm were isolated through a right fronto-orbito-zygomatic craniotomy. The external carotid artery, distal to the origin of the facial artery, was chosen in the neck for an end-to-end microanastomosis. The temporal branch of the MCA was selected for an end-to-side microanastomosis with the radial graft using ten U-clips. The total temporary occlusion time was 13 min. The post-operative course was uneventful.

Conclusion: Endoscopic technique provides improved patient satisfaction, especially in terms of length of the surgical incision, when compared to the conventional approach. Combined with the innovative use of U-clips, this case illustrates how new technologies can simplify ECA-ICA bypass surgery while yielding a better cosmetic and functional outcome.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Carotid Artery, Internal, Dissection / diagnostic imaging
  • Carotid Artery, Internal, Dissection / pathology
  • Carotid Artery, Internal, Dissection / surgery*
  • Cerebral Revascularization / instrumentation
  • Cerebral Revascularization / methods*
  • Cicatrix / prevention & control
  • Craniotomy / methods
  • Endoscopy / methods*
  • Female
  • Forearm / blood supply
  • Forearm / surgery
  • Humans
  • Image Processing, Computer-Assisted
  • Magnetic Resonance Imaging
  • Patient Satisfaction
  • Petrous Bone / pathology
  • Petrous Bone / surgery
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Radial Artery / anatomy & histology
  • Radial Artery / surgery*
  • Radial Artery / transplantation*
  • Radiography
  • Surgical Instruments
  • Treatment Outcome
  • Vascular Surgical Procedures / instrumentation
  • Vascular Surgical Procedures / methods*