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Akio Morita - One of the best experts on this subject based on the ideXlab platform.
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Occipital Artery to Middle Cerebral Artery Bypass: Operative Nuances.
World neurosurgery, 2017Co-Authors: Toshikazu Kimura, Akio MoritaAbstract:Background Superficial temporal Artery (STA)–middle cerebral Artery (MCA) anastomosis is a common procedure for vascular neurosurgeons, and it is used in a variety of diseases. However, there are cases in which the STA is absent or is too hypoplastic to be used as a donor for revascularization. Occipital Artery (OA)–MCA bypass may be a treatment option in these cases. Methods We encountered 4 cases of symptomatic cerebral ischemia in which the STA was absent or unavailable. These cases were treated by revascularization from the OA to the periphery of the MCA. Results By meticulous dissection of the OA to the level of the superior temporal line, the OA could reach the periphery of the Angular Artery and be anastomosed to it in the usual fashion. The patency of the donor Artery was confirmed by magnetic resonance angiography soon after the operation and 3 years later. Conclusions OA-MCA bypass may be a surgical option for cerebral revascularization when the STA is not available.
Ajay K Wakhloo - One of the best experts on this subject based on the ideXlab platform.
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e 042 use of flow diverters in vessels less than 2 5 mm during intracranial aneurysm treatment
Journal of NeuroInterventional Surgery, 2014Co-Authors: Ajit S Puri, Francesco Massari, Samuel Y Hou, M Perras, Christopher Brooks, C Stout, Matthew J Gounis, Ajay K WakhlooAbstract:Introduction/purpose Pipeline Embolization Device (PED) is currently indicated for treatment of large and complex intracranial aneurysms centerd along the cavernous/intradural segment of the internal carotid Artery (ICA) proximal to the Posterior Communicating (PCom) Artery. The purpose of this study is to assess the efficacy and safety of flow diversion treatment in unruptured complex aneurysms centerd along small vessel branches of the anterior and middle cerebral arteries. Materials and methods From August 2013 to December 2013, a total of 3 intracranial aneurysms located along small vessel branches of the anterior circulation in 3 patients (1 man and 2 women; age range, 60–71 years; mean age, 64.6 years) were treated with pipeline embolization device (PED) at our institution. In 2 patients the aneurysms were incidentally found during cerebral angiogram exam performed for additional unruptured intracranial aneurysm treatment planning; in the other case the aneurysm was prior source of a subarachnoid haemorrhage (SAH). The parent vessel size ranged from 1.8 to 2.2 mm, mean 2 mm. Location of the aneurysms was as follows: 2 aneurysms centerd along the pericallosal Artery (1 left, 1 right), branch of the anterior cerebral Artery (ACA), and 1 aneurysm located on the right Angular Artery, branch of the middle cerebral Artery (MCA). In the patient group no family history for intracranial aneurysm is reported. Aneurysms ranged from 2.5 to 3.7 mm in maximal diameter. The technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcome were evaluated. At 6 month follow-up (1 patient) was noted a complete right Angular Artery aneurysm obliteration, with mild in-PED intimal hyperplasia. Results In every case, endovascular treatment was achieved. Immediate angiography demonstrated a intra-aneurysmal contrast stagnation, with parent Artery preservation. No major or minor procedure-related complications were noticed. None of the treated aneurysms experienced bleeding or thrombo-embolic complication intra-, post procedurally or on follow-up. Conclusion Although the experience is limited by the small volume of cases treated with PED for unruptured complex aneurysms centerd along less than 2.5 mm vessel branches of the anterior circulation, the procedure was noted to be a feasible, safe and effective method to obtain aneurysm occlusion without parent vessel occlusion. Disclosures A. Puri: None. F. Massari: None. S. Hou: None. M. Perras: None. C. Brooks: None. C. Stout: None. M. Gounis: None. A. Wakhloo: None.
John Yoo - One of the best experts on this subject based on the ideXlab platform.
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comparison of fibular and scapular osseous free flaps for oromandibular reconstruction a patient centered approach to flap selection
Archives of Otolaryngology-head & Neck Surgery, 2013Co-Authors: Samuel Dowthwaite, Julie A Theurer, Mathieu Belzile, Kevin Fung, Jason H Franklin, Anthony C Nichols, John YooAbstract:Importance Provides an approach to osseous free flap selection for reconstruction of segmental mandible defects that takes into consideration general medical status of the patient and reconstruction requirements; demonstrates the complementary qualities of fibular and subscapular system free flaps; and describes the different surgical indications for lateral border scapular and scapular tip free flaps. Objectives To review our experience with osseous mandible reconstruction comparing the fibular and subscapular system free flaps, determine reconstruction-specific and general health variables that may differ between these patient groups, and present our approach to oromandibular reconstruction. Design Retrospective study. Setting Academic tertiary care medical center. Participants A total of 110 patients (68 male, 42 female) undergoing single-stage oromandibular reconstructions with free-tissue transfers between May 1, 2006, and May 30, 2012. Intervention Single-stage oromandibular reconstruction with free-tissue transfer. Main Outcome Measures Differences in patient demographics, bone and soft-tissue aspects of the reconstruction, operative time, flap outcomes, and major postoperative complications between fibular, lateral scapular border, and scapular tip free flaps. Results A total of 110 patients underwent 113 reconstructions, including 58 fibular free flaps (FFFs) (51.3%) and 55 subscapular system flaps (48.7%). Of the subscapular system free flaps, 27 flaps (49%) were scapular tip free flaps (STFFs) based on the Angular Artery branch of the thoracodorsal pedicle; the remaining 28 cases were lateral scapular border flaps (LSBFs). Patients undergoing reconstruction with FFFs were significantly younger than their subscapular system flap counterparts (56 vs 70 years, P Conclusions and Relevance The FFFs and subscapular flaps are complementary options for oromandibular reconstruction. The FFF is ideal for younger patients, extended defects, multiple osteotomies, and limited soft-tissue requirements. The subscapular system free flaps (LSBF and STFF) are excellent options for (1) elderly patients; (2) those with significant comorbidities, such as peripheral vascular disease; and (3) mandible defects associated with complex soft-tissue requirements. Furthermore, the STFF offers a reliable option to reconstruct short-segment defects, in particular, defects involving the angle of the mandible.
Toshikazu Kimura - One of the best experts on this subject based on the ideXlab platform.
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Occipital Artery to Middle Cerebral Artery Bypass: Operative Nuances.
World neurosurgery, 2017Co-Authors: Toshikazu Kimura, Akio MoritaAbstract:Background Superficial temporal Artery (STA)–middle cerebral Artery (MCA) anastomosis is a common procedure for vascular neurosurgeons, and it is used in a variety of diseases. However, there are cases in which the STA is absent or is too hypoplastic to be used as a donor for revascularization. Occipital Artery (OA)–MCA bypass may be a treatment option in these cases. Methods We encountered 4 cases of symptomatic cerebral ischemia in which the STA was absent or unavailable. These cases were treated by revascularization from the OA to the periphery of the MCA. Results By meticulous dissection of the OA to the level of the superior temporal line, the OA could reach the periphery of the Angular Artery and be anastomosed to it in the usual fashion. The patency of the donor Artery was confirmed by magnetic resonance angiography soon after the operation and 3 years later. Conclusions OA-MCA bypass may be a surgical option for cerebral revascularization when the STA is not available.
Wolfgang Zemann - One of the best experts on this subject based on the ideXlab platform.
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free thoracodorsal perforator scapular flap based on the Angular Artery tdap scap aa clinical experiences and description of a novel technique for single flap reconstruction of extensive oromandibular defects
Journal of Cranio-maxillofacial Surgery, 2019Co-Authors: Mauro Pau, Jurgen Wallner, Matthias Feichtinger, Michael Schwaiger, Jan Egger, Janos Cambiasodaniel, R Winter, Norbert Jakse, Wolfgang ZemannAbstract:Abstract Purpose The reconstruction of oromandibular defects can be challenging, particularly when considerable amounts of bone and soft tissues are lost. In such cases, the use of a single flap may be unsatisfactory and a concomitant free flap is needed. Here we present a chimeric, thoracodorsal perforator-scapular free flap based on the Angular Artery of the subscapular system (TDAP-Scap-aa) as an alternative technique for single flap reconstruction of extensive oromandibular defects. Materials and methods The authors studied patients who underwent reconstructions of extensive oromandibular defects with a TDAP-Scap-aa free flap. The operative technique and the clinical experiences are described. Postoperatively, surgical complications were classified with the Clavien-Dindo Classification. Results Five male patients (59.4 ± 8.8 years) were treated with the TDAP-Scap-aa. Average sizes for harvested hard and soft tissue components, which are both included in the flap and completely independently from each other, were 10.4 ± 1.5 cm of bone length, 2.6 ± 0.3 cm of bone height, 11.6 ± 4.8 cm of skin paddle length and 8.4 ± 1.7 cm of skin paddle width. The overall mean operation time (cut-suture) was 14.6 ± 0.9 h. The postoperative follow-up was 6 months. No complications requiring surgical treatment as well as donor site nerve damages were observed. Conclusions In comparison to other double free flaps, the TDAP-Scap-aa offers several advantages such as higher amounts of hard and soft tissues without prolonged operation times, and provides satisfying aesthetic outcomes and little donor site morbidity due to the preservation of muscle and nerve structures. Therefore, the TDAP-Scap-aa constitutes a clinically reliable alternative in extensive oromandibular defect reconstruction.