Extracranial-Intracranial Bypass with Plastic Surgery Using a Y-Shaped Vein Graft from the Hand – a Case Series and Guide to Collaboration
Notice bibliographique
Résumé
Background: While extracranial-intracranial (EC-IC) bypass is commonly performed by neurosurgeons with expertise in cerebrovascular surgery, it can also be performed together with microvascular plastic surgeons. This paper outlines a guide for collaboration between plastic surgeons and neurosurgeons in performing EC-IC bypass along with two case examples using the superficial temporal artery (STA), one of which required the use of a dorsal hand Y-shaped vein graft, which has not been described in the literature to date. Methods: Patients who underwent EC-IC bypass with involvement of both neurosurgery and plastic surgery at a single center between January 2020 and January 2023 were included. Demographics, clinical data, and postoperative outcomes were recorded. Results: The first case was a patient with a giant partially thrombosed left middle cerebral artery (MCA) aneurysm which required partial resection and a double-barrel STA-M2 bypass using a Y-shaped vein graft from the hand anastomosed to two M2 branches. The postoperative CT angiography showed filling of the distal MCA branches and the patient was discharged to the ward two days later with moderate aphasia and paresis which improved with rehabilitation. The second case was a patient with a calcified embolism in the proximal left MCA which failed both endovascular and open embolectomy, so an emergent STA-M2 bypass was performed. The postoperative CT and MRI angiography showed that the bypass was patient and there was flow to the distal left MCA. The patient was eventually discharged home with mild but improving right-sided weakness and aphasia. In both cases, the donor vessel preparation and the microvascular anastomoses were performed exclusively by the plastic surgery team. Conclusion: Given that microvascular surgery is increasingly being performed by plastic surgeons, the wide experience of plastic surgery in microsurgery should be used advantageously in EC-IC bypass. This study provides a Canadian perspective on planning and performing EC-IC bypass jointly with neurosurgeons and plastic surgeons to optimize efficiency and outcomes.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».