Name of the Procedure:

Anastomosis, arterial, extracranial-intracranial (e.g., middle cerebral/cortical) arteries

Summary

This procedure involves surgically connecting an artery outside the skull to an artery inside the brain to improve blood flow to areas that may be at risk due to blocked or narrowed arteries.

Purpose

The procedure is designed to improve blood flow to the brain, thereby reducing the risk of stroke or other cerebrovascular problems caused by blocked or narrowed arteries. Its goal is to ensure that the brain receives an adequate supply of oxygen-rich blood.

Indications

• Patients with significant blockages or narrowing in the carotid artery or other major arteries supplying the brain.
• Individuals who have had previous strokes or transient ischemic attacks (TIAs) and are at high risk of recurrence.
• Certain cases of Moyamoya disease, a rare disorder where arteries at the base of the brain are constricted.

Preparation

• Patients may need to undergo fasting for a certain period before surgery.
• Medications might need to be adjusted or temporarily stopped, particularly blood thinners.
• Pre-operative imaging tests such as CT scans, MRIs, or angiography to map the arteries and plan the surgery.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the scalp to access the skull.
3. A small piece of the skull bone is removed to allow access to the brain.
4. An artery from outside the skull (extracranial) is connected to an artery inside the skull (intracranial) through meticulous microsurgery.
5. The bone piece is replaced, and the incision is closed.
6. Continuous monitoring of blood flow is done during the procedure to ensure proper connection.

Duration

The procedure typically lasts between 3 to 5 hours.

Setting

This surgery is performed in a hospital operating room equipped with specialized surgical and monitoring equipment.

Personnel

• Neurosurgeon: leads the procedure.
• Surgical assistants and nurses: assist the surgeon throughout the surgery.
• Anesthesiologist: administers anesthesia and monitors the patient’s vital signs.

Risks and Complications

• Common risks include infection, bleeding, and blood clots.
• Rare complications can involve stroke, seizures, or failure of the grafted artery to provide adequate blood flow.
• Possible issues with wound healing or reactions to anesthesia.

Benefits

• Reduced risk of stroke.
• Improved blood flow to the brain.
• Potential to significantly improve quality of life for patients with severe arterial blockages.

Recovery

• Patients are usually monitored in the ICU for the first 24 to 48 hours.
• Hospital stay may range from 3 to 7 days.
• Instructions include wound care, activity restrictions, and medication management.
• Follow-up appointments for monitoring recovery and arterial blood flow.

Alternatives

• Medical management with anticoagulants and antiplatelet drugs.
• Carotid endarterectomy for specific arterial blockages.
• Endovascular stenting. Each alternative has its own risks, benefits, and suitability based on the patient’s condition and overall health.

Patient Experience

During the procedure, patients will be under general anesthesia and will not feel pain. Postoperatively, they may experience some discomfort at the incision site, managed with pain medication. Recovery involves gradual resumption of activities and close monitoring to ensure successful recovery and graft function.