The occipital artery as an alternative donor for low-flow bypass to anterior circulation after ICA occlusion failure prior to exenteration for an atypical cavernous sinus meningioma: A technical case report.

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The occipital artery as an alternative donor for low-flow bypass to anterior circulation after ICA occlusion failure prior to exenteration for an atypical cavernous sinus meningioma: A technical case report.

World Neurosurg. 2017 Sep 05;:

Authors: Hanakita S, Lenck S, Labidi M, Watanabe K, Bresson D, Froelich S

Abstract
BACKGROUND: and Importance: In skull-base tumors involving the cavernous sinus (CS), indications for aggressive resection are sparse and must be carefully examined because of their invasiveness. With careful evaluation, techniques including internal carotid artery (ICA) sacrifice with or without extracranial-intracranial (EC-IC) bypass may still be an option in some cases. In addition, previous surgery with the sacrifice of potential donor vessels requires adjusting the revascularization strategy. Here, we describe an OA-MCA bypass prior to the skull-base tumor resection.
CLINICAL PRESENTATION: A 47-year-old woman with a recurrent cavernous sinus meningioma was referred to our department. Because of tumor recurrence after radiotherapy and its rapid progression, radical resection including part of the CS was planned. A balloon test occlusion (BTO) was performed and showed good tolerance. Thus, an endovascular ICA occlusion was performed. The patient eventually experienced motor deficits and aphasia post-surgery. Therefore, bypass surgery using an occipital artery (OA)-middle cerebral artery (MCA) anastomosis was performed. The patient showed no exacerbation of symptoms after bypass surgery, and subsequently underwent tumor resection.
CONCLUSION: The reliability of BTO in the management of giant aneurysms may not be similarly applicable to skull base tumors. If hypo-perfusion symptoms occur following occlusion of the ICA, a surgical revascularization procedure should be considered because of the risk of ischemic stroke following tumor resection. For patients whose superficial temporal artery is not available, the OA can be a valuable alternative donor for low-flow bypass.

PMID: 28887285 [PubMed - as supplied by publisher]

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