Submandibular-infratemporal interpositional carotid artery bypass for cranial base tumors and giant aneurysms

OBJECTIVE: Cerebral revascularization is an important strategy in the surgical management of some complex cranial base tumors and unclippable aneurysms. A high-flow bypass may be necessary in planned carotid occlusion or sacrifice. The cervical-to-supraclinoid internal carotid artery bypass or cervical carotid-to-middle cerebral artery bypass are useful procedures to bypass lesions at the base of the cranium. We describe technical modifications of the submandibular-infratemporal interpositional saphenous vein (or radial artery) graft bypass technique specifically designed to avoid removal of the zygoma. METHODS: The saphenous vein or radial artery interpositional graft is tunneled through a burr hole created in the floor of the middle fossa via a submandibular-infratemporal route avoiding removal of zygoma and attachments of the masseter or temporalis muscles. RESULTS: The technique is demonstrated in one patient with removal of a malignant cavernous sinus tumor and in another patient with an unclippable giant carotid bifurcation aneurysm. CONCLUSION: The advantages of this approach include preservation of the facial anatomy and creation of a short and safe route for passage of the saphenous vein or radial artery graft.