title: Submandibular-infratemporal interpositional carotid artery bypass for cranial base tumors and giant aneurysms.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA. william.couldwell@hsc.utah.edu
authors.forename: William T
authors.initials: WT
authors.lastname: Couldwell
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
authors.forename: Amin
authors.initials: A
authors.lastname: Amini
authors.forename: Peter
authors.initials: P
authors.lastname: Kan
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002339:Carotid Arteries / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D003399:Craniotomy / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000637:transplantation; D012501:Saphenous Vein / Q000637:transplantation*; D019291:Skull Base / Q000601:surgery; D019292:Skull Base Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D015050:Zygoma / Q000601:surgery