Submandibular high-flow bypass in the treatment of skull base lesions: an analysis of long-term outcome

Neurosurgery. 2012 Sep;71(3):645-50; discussion 650-1. doi: 10.1227/NEU.0b013e318260fedd.

Abstract

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.

Conclusion: 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cerebral Revascularization / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Aneurysm / surgery
  • Male
  • Middle Aged
  • Mucormycosis / surgery
  • Retrospective Studies
  • Saphenous Vein / transplantation
  • Skull Base / surgery*
  • Skull Base Neoplasms / surgery
  • Treatment Outcome
  • Young Adult