Common Carotid−Greater Saphenous−M2 Bypass for Myoepithelial Carcinoma Encasing the Carotid Artery

• Published in: World neurosurgery 2023-09, Vol.177, p.19-19
• Main Authors: Tonetti, Daniel A., Rinaldo, Lorenzo, Raygor, Kunal P., Dubnicoff, Todd B., El-Sayed, Ivan H., Abla, Adib A.
• Format: Article
• Language: English
• Subjects: Cerebral microsurgical revascularization; Internal carotid artery; Malignant peripheral nerve sheath tumor; Middle cerebral artery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2023.05.099

Revascularization of the anterior circulation using a high-capacitance graft is sometimes necessary for treatment of cervical tumors encasing the internal carotid artery (ICA). In this surgical video, we aim to demonstrate the technical nuances of high-flow extra-to-intracranial bypass using a saphenous vein graft. The patient is a 23-year-old female who presented with a 4-month history of an enlarging left-sided neck mass, dysphagia, and 25-lb weight loss. Computed tomography and magnetic resonance imaging demonstrated an enhancing lesion encasing the cervical ICA. The patient underwent an open biopsy that established a diagnosis of a myoepithelial carcinoma. The patient was advised to undergo attempted gross total resection, which would require sacrifice of the cervical internal carotid artery. After the patient failed a balloon test occlusion of the left ICA, it was decided to perform a cervical ICA to middle cerebral artery M2 bypass using a saphenous vein graft, followed by tumor resection in staged fashion. Postoperative imaging demonstrated complete tumor removal and filling of the left anterior circulation via the saphenous vein graft. Video 1 discusses important preoperative and postoperative considerations, as well as highlights the technical nuances of this complex procedure. High-flow ICA to middle cerebral artery bypass using a saphenous vein graft can be employed to facilitate gross total resection of malignant tumors encasing the cervical internal carotid artery.