Craniotomy for extracranial-intracranial revascularization

Craniotomy for extracranial-intracranial revascularization

File:EC-IC Bypass .jpg
Anesthesia type	General
Airway	ETT
Lines and access	PIV x 2 Art line CVC
Monitors	Standard ASA 5-lead EKG Core temp UOP ABG CVP EEG
Primary anesthetic considerations
Preoperative	Smooth induction Maintain CPP
Intraoperative
Postoperative
Article quality
Editor rating	Comprehensive
User likes	2

Extracranial-intracranial (EC-IC) revascularization (also referred to as EC-IC bypass) is a surgical procedure to increase cerebral blood flow. The procedure involves connecting a branch of the external carotid artery (typically the superficial temporal artery) to a branch of the internal carotid artery (typically the middle cerebral artery). The anastomosis can be achieved via a vein graft or a direct connection.

EC-IC bypass is generally indicated for severe stenosis or occlusion of intracranial arteries that is resulting in focal neurological symptoms. In children, this procedure is used to treat Moya-moya disease.

Preoperative management

Patient evaluation

System	Considerations
Neurologic
Cardiovascular	Hypertension is a common adaptive response to maintain CPP. "Normalization" of BP may be undesirable from a CPP perspective Patients may have generalized vascular disease, including CAD.
Respiratory
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

• EKG
• Echo (if concern for cardiovascular disease)
• Coronary angiography (depending on cardiac risk factors)
• Complete blood count
• Chemistry panel
• Coagulation panel

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications