External carotid artery-vein-posterior cerebral artery anastomosis

Since Yasargil and Donaghy pioneered the superficial temporal artery-brain artery anastomosis in 1967 to treat cerebral ischemic diseases, various forms of extracranial-cranial anastomosis have emerged in an endless stream, counting up to 10 species, each with its own advantages and disadvantages. . In 1982, Sundt first reported this type of surgery. Treatment of diseases: cerebral ischemic diseases Indication External carotid artery-venous-posterior artery anastomosis is applicable to: 1, basilar artery stenosis or occlusion, and symptoms of cerebral ischemia, such as progressive stroke, transient ischemic attack, lacunar infarction or orthostatic cerebral ischemia. 2, large vertebral-basal artery aneurysm, can not clamp the neck, need to ligature vertebral artery or basilar artery for treatment, and collateral blood supply. Contraindications 1. Older patients have serious systemic diseases such as lung, heart, kidney, liver disease, and diabetes. 2. There are serious and persistent neurological dysfunctions. 3, although the basilar artery stenosis or occlusion, but no neurological symptoms, cerebral blood flow (CBF) is also normal, indicating that the collateral circulation is sufficient. Preoperative preparation 1, adequate cerebral angiography should be performed to fully understand the condition of cerebral vascular stenosis and collateral circulation. 2. CT scan to determine the presence or extent of cerebral infarction. 3, cerebral blood flow measurement. 4. Prepare the scalp as usual. 5. Give preventive antibiotics. Surgical procedure 1, take the great saphenous vein, length 20 ~ 25cm. Rinse with heparinized saline and fill it up. Ligation of all branches and repair if leaked. 2. Craniotomy of the ankle bone flap on the ear. Inject mannitol and release cerebrospinal fluid for retraction of the brain. Lift the temporal lobe until the free edge of the cerebellum, cut the arachnoid of the ring pool, and you can see that the second segment of the posterior cerebral artery (P2) bypasses the outside of the cerebral peduncle. A section of the artery that was not about 1.5 cm long was selected as the recipient artery. 3. The following jaw angle is the midpoint, and a slanting incision is made along the leading edge of the sternocleidomastoid muscle to expose and separate the external carotid artery. 4, the distal end of the great saphenous vein (foot end) is placed on the 8th or 10th rubber catheter end, lined tightly, through the subcutaneous tunnel through the head incision through the subcutaneous tunnel, the tunnel is located in front of the ear Outside the bow. The heparin saline is injected into the vein through the catheter, and the vein is clamped proximally, so that the vein is filled with heparin saline. 5, intravenous injection of heparin 4000 ~ 5000U. The posterior cerebral artery was blocked with two non-invasive arterial clips as the proximal and distal segments of the anastomosis. The arterial wall was cut and the end-to-side anastomosis was performed with the 8-0 nylon line. Then open the distal and proximal arterial clips in turn. At this point, the blood flow is blocked by the one-way flap in the vein and does not flow back into the vein. Adjust the length of the vein so that it can be placed in the middle of the skull without tension. The distal end (foot) of the vein is then end-to-end or end-to-side anastomosis with the external carotid artery. complication Contusion of the temporal lobe, hematoma in the brain, cerebral edema, etc.