Intracranial in situ side-to-side microvascular anastomosis: principles, operative technique, and applications.
OBJECTIVE
Side-to-Side microvascular anastomosis is a revascularization technique used to create an artificial conduit between two similar adjacent vessels. This technique is used for microsurgical clipping of aneurysms, when indicated. It is important to study the angiographic results, both immediate and long term, along with the clinical outcomes and indications of the procedure.


METHODS
Fifteen patients who had this procedure over a fourteen-year period were reviewed for patency of bypass by intra-arterial digital subtraction angiography (DSA) and computed tomographic arteriograms (CTA) and their clinical outcomes were studied. The mean age of the study group was 53.4 years and mean angiographic follow up period was 14 months.


RESULTS
All surviving patients (14 patients) had patent anastomosis with good clinical outcomes. None of the patients developed a clinically manifested stroke due to the procedure, while one had a small asymptomatic infarct detected post operatively.


CONCLUSIONS
This technique is a useful and durable solution for correcting critical stenosis or complete occlusion of the vessels, while clipping intracranial aneurysms.
Ramanathan
Dinesh
D
Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Hegazy
Ahmed
A
Mukherjee
Sudipta Kumar
SK
Sekhar
Laligam N
LN
D000328:Adult; D000368:Aged; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000295:instrumentation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D011859:Radiography; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome