Background: The indication of extracranial-intracranial (EC-IC) bypass surgery is likely to be limited, because the prognosis for ischemic stroke improves with better outcomes with medical therapy. Therefore, to achieve the maximum benefit in selected cases, an individualized surgical plan tailored to anatomical differences and the purpose of the surgery is necessary. We describe our practical application of 3-D multifusion imaging for “tailored” bypass surgery.
Methods: We selected the ideal recipient artery and simulated the craniotomy preoperatively using 3-D multifusion imaging on a general purpose workstation in 13 cases of EC-IC bypass treated in Kokura Memorial Hospital between October 2011 and October 2012. We identified discrepancies between imaging and the actual intra-operative view, and modified the image editing and operative procedure.
Results: In all 13 cases, bypass flow was maintained. There were positional deviations between the simulated craniotomy and the intra-operative view in two cases initially. In another two cases, we could not select the recipient artery because of insufficient visualization of the brain surface. Both problems were correctable.
Conclusion: We accurately identified the recipient artery that we had selected pre-operatively. This technique can be a stepping stone to “tailored bypass” and could be applied to various cerebrovascular surgeries.