Craniotomy for extracranial-intracranial revascularization

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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
1

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
  • Patients typically presenting with focal neurologic symptoms. Pre-existing deficits should be well characterized and documented.
Cardiovascular
  • Hypertension is a common adaptive response to maintain CPP. A normal BP may be undesirable in the setting of severe cerebrovascular disease.
  • Patients may have generalized vascular disease, including CAD.
Hematologic
  • Patients often on aspirin through day of surgery
  • Anticoagulants impacting PT/PTT typically discontinued 1 week prior to surgery
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
  • Cerebral angiography performed to identify cause of neurologic symptoms

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

Induction and airway management

Positioning

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants

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

References