Extracranial-Intracranial Bypass with Plastic Surgery Using a Y-Shaped Vein Graft from the Hand – a Case Series and Guide to Collaboration
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".