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| Year : 1981 | Volume
: 27
| Issue : 3 | Page : 189-190a |
Extracranial to intracranial bypass (a case report).
Nagpal RD
How to cite this article:
Nagpal R D. Extracranial to intracranial bypass (a case report). J Postgrad Med 1981;27:189-190a |
The extracranial to intracranial arterial bypass operation is done to augment the blood supply to an ischaemic part of the brain. This forms the most important indication. The other indications have been added on later. The methods, selection of patients and the results have been discussed in the preceding article (Indications for extracranial to intracranial arterial bypass operation) by Grote and Schonmayer.[1] I am reporting here the first such operation performed in the city.
PBC was a 62 year old, right handed man being treated for dementia by the hospital psychiatrists. The symptoms were loss of recent memory for one year, irritability and difficulty in micturition. The relatives also noticed abnormal behaviour in the form of restlessness, a tendency to stay away from home without an obvious cause and unnatural outbursts of temper. On examination, he had a mask like facies, monotonous speech, bradykinesia, a short shuffling steps gait, and was well oriented. The rest of the nervous system examination did not yield any positive findings. The cardiovascular, respiratory and alimentary systemic examination did not show any abnormality.
Investigations:
Haemogram, blood sugar, blood urea nitrogen, serum creatinine, serum VDRL, chest X-ray and the ECG showed no abnormality. A right sided percutaneous common carotid angiogram was performed to check for hydrocephalus. The angiogram showed middle cerebral artery trunk occlusion beyond the first branch [Fig. 1] The subsequent films showed some retrograde opacification of the distal middle cerebral branches. There was no evidence of ventricular dilatation. The left percutaneous common carotid angiogram showed evidence of mild arteriosclerotic disease of the intracranial vessels.
Operation:
The patient underwent an anastomosis between the right superficial temporal artery and the angular branch of the middle cerebral artery. The technique used was similar to the one described by Grote and Shonmayer.[1] The post operative period was uneventful and on the 8th post-operative day, the catheter right external carotid angiogram showed a patent anastomosis with opacification of the middle cerebral branches not seen on the pre-operative angiogram [Fig. 2]
A case is presented describing the first extra-intracranial bypass operation performed in the city. The patient presented with a dementia problem and the angiogram showed a middle cerebral artery main stem block. The benefit from the operation is too early to assess.
The performance of such an operation is possible only with the aid of an operating microscope, fine short handled forceps and scissors, bipolar coagulator and 10-0 monofilament nylon.
The author is thankful to Dr. C. K. Deshpande, Dean. Seth G.S. Medical College and K.E.M. Hospital, Bombay400 012 for his kind permission to publish this case. The author also thanks M/s. Ethicon through Johnson and Johnson of Bombay for procurement of 10-0 monofilament nylon sutures.
| 1. | Grate, E. and Schonmayer, R.: Indications for extracranial to intracranial arterial bypass operation. J. Postgrad. Med., 27: 143-147, 1981.  |
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