Submandibular high-flow bypass in the treatment of skull base lesions: an analysis of long-term outcome.
BACKGROUND
Cerebral bypass surgery remains an integral part of the treatment of complex skull base tumors and unclippable aneurysms.


OBJECTIVE
The authors retrospectively analyzed a single-surgeon experience using a high-flow submandibular-infratemporal saphenous vein graft bypass technique after carotid artery sacrifice in the resection of complex skull base tumors and carotid isolation in unclippable aneurysms.


METHODS
Data on indications, surgical technique, bypass patency, complications, and outcome were collected for patients treated with adjunctive submandibular high-flow bypass for skull base lesions.


RESULTS
Eleven patients (age range, 13-77 years) were treated for various skull base lesions: 4 patients were treated for skull base tumors with resection of the internal carotid artery (ICA), 6 were treated for aneurysms not amenable to clipping, and one was treated for invasive Mucor infection. With the use of a saphenous vein graft, a high-flow bypass was created from the high cervical ICA or external carotid artery to ICA or middle cerebral artery by means of a submandibular-infratemporal route. Postoperative angiography indicated bypass patency in 10 of 11 patients. There was no operative mortality. Follow-up of up to 12 years (mean, 56 months) was achieved.


CONCLUSIONS
Direct high-flow submandibular-infratemporal interpositional saphenous vein bypass graft is an effective and durable technique for the treatment of complex skull base lesions where ICA revascularization is indicated.
Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84132, USA. neuropub@hsc.utah.edu
William T
WT
Couldwell
Philipp
P
Taussky
Walavan
W
Sivakumar
D000293:Adolescent; D000328:Adult; D000368:Aged; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000601:surgery; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult