Combined Direct and Indirect Cerebral Revascularization Using Local and Flow-Through Flaps.

Area of Science:

• Neurosurgery
• Plastic Surgery
• Vascular Surgery

Background:

• Extracranial-intracranial bypass is crucial for treating ischemic conditions such as moyamoya disease and intracranial aneurysms.
• Local and flow-through flaps present an additional method for cerebral revascularization.

Purpose of the Study:

• To evaluate the efficacy of local and flow-through flaps in cerebral revascularization and soft tissue reconstruction.
• To present a series of combined neurosurgery and plastic surgery procedures.

Main Methods:

• Retrospective review of nine patients undergoing ten direct arterial bypass procedures and nine indirect revascularization/soft tissue reconstructions.
• Utilized flow-through and pedicled flaps, with superficial temporal and facial vessels as vascular inflow.
• Targeted middle cerebral artery and anterior communicating artery for arterial bypass.

Main Results:

• Procedures were performed for moyamoya disease (n=8) and intracranial aneurysms (n=2).
• Soft tissue transfer was indicated for infected cranioplasty (n=1) and indirect revascularization (n=8).
• All flaps survived without donor-site complications; one direct graft failure was compensated by indirect flap vascularization.

Conclusions:

• Local and flow-through flaps effectively enhance combined direct and indirect revascularization and soft tissue coverage.
• Early outcomes show minimal morbidity, but long-term results require further investigation.
• These combined procedures represent a valuable addition to neurovascular treatment options.