Andrey V. DubovoyIl’inskaya hospital , Russian Federation
Title: Regarding the manuscript by A.A. Shulgina et al. Combined double-barrel direct and indirect bilateral cerebral revascularization in the treatment of moyamoya disease
A method for creating a middle-flow extra-intracranial vascular bypass between the maxillary artery and any large segment of the intracranial artery, clinically tested on 26 patients, is proposed. The method differs from previously proposed methods in the ease of surgical access and search for the maxillary artery in the infratemporal fossa. A pterional craniotomy is performed with preliminary partial resection of zygomatic arch (from zygomatic process of frontal bone to the middle of zygomatic arch). The maxillary artery is located inside fat layer between temporal muscle and external pterygoid muscle, posteriorly to the lateral wall of the orbit, at the level of pterygoid process of sphenoid bone. Next, a bypass of the maxillary artery with an interposition graft from the radial artery is performed (end-to-side or end-to-end fashion). The other end of interposition graft is connected by an end-to-side fashion to any major intracranial artery.
Experience and Skills:
1. Surgical treatment of traumatic brain injury.
2. Surgical treatment of intracerebral hemorrhage, including endoscopic methods.
3. Surgical treatment of cerebral aneurysms of any complexity: clipping, including different revascularization methods.
4. Surgical treatment of cerebral AVM’s: microsurgical resection.
5. Surgical treatment of cavernous malformations, including difficult localizations (brain stem, thalamus, cerebellum, basal ganglia’s).
6. Surgical revascularization of the brain: low-flow bypass, maxillary artery bypass, high-flow bypass, intra-intracranial bypass.
7. Microvascular decompression (trigeminal & glosso-pharyngeal neuralgia, hemifacial spasm).
The experience of surgical treatment more than 2000 cerebral aneurysms, mostly complex cases, requiring revascularization. The experience of removing more than 200 arteriovenous malformations of the brain. Experience in surgery of more than 40 cavernous malformations of the brain stem. More than 75 high-flow bypasses, over 300 low-flow bypasses (STA-MCA, STA-PCA, STA-SCA, OA-PICA), over 50 intra-intracranial bypasses, 25 maxillary artery middle-flow bypasses, bonnet bypass.