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| Name | MCA-A1 ACA Intracranial-Intracranial Bypass for Ruptured Dissecting Pseudoaneurysm: 3-D Video |
| Video Uploader | Video From NEUROSURGERY Journal |
| Upload Date | This Video Uploaded At 20-09-2015 14:00:35 |
| Video Discription | This video demonstrates an intracranial-to-intracranial (IC-IC) bypass, the middle cerebral artery-to-A1 anterior cerebral artery (MCA-A1 ACA) bypass, used to treat a dissecting pseudoaneurysm. This 75-year-old woman presented with subarachnoid hemorrhage from a dominant A1 ACA pseudoaneurysm. The contralateral A1 ACA was atretic, which prevented treatment with simple pseudoaneurysm trapping. The MCA-A1 ACA bypass was needed to revascularize the ACA territories bilaterally, and a saphenous vein interposition graft (SVG) was needed for the reconstruction because her radial arteries were occluded by atherosclerosis. An orbitozygomatic craniotomy provided adequate subfrontal exposure, and the proximal MCA anastomosis was performed first in order to minimize ACA ischemia time. The deep suturing of the distal end-to-end anastomosis was performed intraluminally. Mismatch between the SVG and the distal A1 ACA made this anastomosis difficult, and an aneurysm clip was needed to close some extra SVG along the suture line. Intra-operative indocyanine green angiography and post-operative digital subtraction angiography demonstrated robust flow through the bypass. The patient recovered to her premorbid baseline without new neurological deficit. This case demonstrates important technical nuances of bypass with interposition grafts, and the importance of having IC-IC techniques in our revascularization repertoire. |
| Category | Science & Technology |
| Tags | Science & Technology Download MP4 | Science & Technology Download MP3 | Science & Technology Download MP4 360p | Science & Technology Download MP4 480p | Science & Technology Download MP4 720p | Science & Technology Download MP4 1080p |
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