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


METHODS
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.


CONCLUSIONS
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.
Department of Neurosurgery, Fondazione Istituto Neurologico Carlo Besta, Milano, Italy. ferrolipaolo@hotmail.com
P
P
Ferroli
G
G
Bisleri
P
P
Nakaji
E
E
Albanese
F
F
Acerbi
G
G
Polvani
G
G
Broggi
D000368:Aged; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000295:instrumentation / Q000379:methods*; D002921:Cicatrix / Q000517:prevention & control; D003399:Craniotomy / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005542:Forearm / Q000098:blood supply / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D017060:Patient Satisfaction; D010579:Petrous Bone / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D017534:Radial Artery / Q000033:anatomy & histology / Q000601:surgery* / Q000637:transplantation*; D011859:Radiography; D013525:Surgical Instruments; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*