title: Anterior cerebral artery amputation and salvage repair of internal carotid artery tear: technical case report.
abstract: OBJECTIVE
  We describe a novel technique used to repair an unanticipated tear of the internal carotid artery (ICA) requiring anterior cerebral artery (ACA) amputation to allow primary repair of the arteriotomy.
  
  
  METHODS
  A 59-year-old woman underwent an orbitozygomatic craniotomy to treat a large, suprasellar, thyroid-stimulating hormone-secreting adenoma. During resection, an incidental ICA tear occurred opposite the exit of the middle cerebral artery.
  
  
  METHODS
  After an ICA tear on the wall opposite the middle cerebral artery occurred, clips were placed on the ICA, middle cerebral artery, and ACA. Primary closure was not feasible without critically stenosing the ICA. The ipsilateral ACA was clipped and amputated just distal to its origin. The relaxation afforded by amputating the ACA allowed primary suture repair of the arteriotomy. A clip was placed on the proximal ACA stump. The distal ACA stump revealed good backflow and was also clipped.
  
  
  CONCLUSIONS
  When an arteriotomy of a large intracranial artery cannot be repaired primarily, creative alternatives must be considered. Amputation of a branch artery with sufficient collateral flow is a method to afford adequate relaxation for primary repair of an arteriotomy. This novel method should be considered in the armamentarium of neurosurgeons to minimize the impact of potentially disastrous vascular complications.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA. neuropub@chw.edu
authors.forename: Scott D
authors.initials: SD
authors.lastname: Wait
authors.forename: Steven W
authors.initials: SW
authors.lastname: Chang
authors.forename: Brendan D
authors.initials: BD
authors.lastname: Killory
authors.forename: William L
authors.initials: WL
authors.lastname: White
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
mesh_terms: D000236:Adenoma / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D000671:Amputation, Surgical / Q000379:methods; D020771:Anterior Cerebral Artery / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*; D020212:Carotid Artery Injuries / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D002941:Circle of Willis / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010911:Pituitary Neoplasms / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D019291:Skull Base / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*