gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Identification of the optimal cortical target point for standard extra-intra cranial bypass surgery

Indentifizierung des optimalen cortical Target Point für extra-intrakranielle Bypass-Operationen

Meeting Abstract

  • corresponding author P.G. Peña-Tapia - Klinik für Neurochirurgie, Klinikum Mannheim, Universität Heidelberg
  • A. Kemmling - Abteilung für Neuroradiologie, Klinikum Mannheim, Universität Heidelberg
  • M. Czabanka - Klinik für Neurochirurgie, Klinikum Mannheim, Universität Heidelberg
  • P. Vajkoczy - Klinik für Neurochirurgie, Klinikum Mannheim, Universität Heidelberg
  • P. Schmiedek - Klinik für Neurochirurgie, Klinikum Mannheim, Universität Heidelberg

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSO.03.08

The electronic version of this article is the complete one and can be found online at:

Published: April 11, 2007

© 2007 Peña-Tapia et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The Extra-Intracranial Arterial Bypass (EIAB) surgery is a well recognized technique for the treatment of a selected group of patients with cerebrovascular hemodynamic insufficiency. Altough many modifications of the original description have been reported, the procedure has never been standarized and uniformly admitted and specifically it has not been clear where to perform the craniotomy to find the best recipient artery. In order to expose the most suitable recipient vessel in a consistent way, and to standardize the surgical technique, we developed a novel device that allows the surgeon the preoperative identification of the end of the Sylvian Fisure, where the most appropriate arteries for the anastomosis emerge.

Methods: A template consisting of a transparent surface with 2 crossing lines in a 90 degrees angle was created. At the junction point, a 2cm plug was inserted, and 6cm above this point, on the vertical line, a hole was made. The plug was inserted in the External Acoustic Meatus and the horizontal reference was aligned with the outer cantus of the eye, the hole on the vertical reference marked our target. Centered at this point, a 3cm Trephination was used in a consecutive series of 30 patients, 19 male, 11 female, mean age 56 yrs. with cerebrovascular hemodynamic insuficiency, to perform an EIAB. Two patients received bilateral bypasses. In most of them sepecial MRI sequences (TOF and MP-Rage) were performed to predict the intraoperative findings.

Results: In all cases at least one appropriate recipient artery was found on the exposed brain, and in 69% of the cases two or more. Intraoperative ICG-Angiography showed a bypass patency of 100%. Postoperative DSA showed in 26 patients a bypass filling grade II or III, in 3 patients the filling grade was I, and in 3 cases DSA was not performed. The correlation between arterial TOF-MRI and intraoperative findings was excelent.

Conclusions: The introduction of the described device in the EC-IC Bypass surgery, to identify the cortical target point for the anastomosis, and the performance of a 3cm Trephination at this point, represent important contributions to standardize its surgical technique, to make it safer and less invasive. The arterial TOF-MRI is a useful tool in the pre-operative evaluation of the brain's cortical vasculature for this kind of surgery.