gms | German Medical Science

A curative surgical treatment of head and neck tumors or central skull base tumors may necessitate the sacrifice of the common or internal carotid artery. However, a significant portion of patients will not tolerate this manoeuvre due to an inadequate collateral blood blow to the brain and, therefore, need a high-flow revascularization procedure for flow replacement prior to radical tumor removal. So far, however, high-flow bypass surgery using saphenous vein or radial artery grafts has been considered to be associated with an inacceptably high surgical risk and as a consequence incomplete tumor removal followed by adjuvant therapies has been preferred over an aggressive surgical approach. Recently, however, considerable progress has been made in patient selection, in individualizing and tailoring the revascularization procedure, and in developing surgical means to reduce the perioperative stroke risk. In this respect, the single most important innovation in high-flow bypass surgery is the development and clinical introduction of the Excimer Laser-assisted non-occlusive anastomosis technique which circumvents the need for temporary artery occlusion of cerebral blood vessels. The current presentation will report our recent experiences with these novel techniques in high-flow bypass surgery as well as our results in using high-flow bypass surgery in the treatment of complex aneurysms. Finally, the potential of high-flow bypass surgery for the interdisciplinary therapy of compex head and neck tumors will be discussed.