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"Bonnet bypass" using a radial artery interposition graft-how I do it
Rajiv K Khajuria1, Milad Neyazi1, Katharina Faust1
1Department of Neurosurgery, Düsseldorf University Hospital, Heinrich-Heine University Düsseldorf, North Rhine-Westphalia, 40225, Düsseldorf, Germany.
Insights
The Bonnet bypass offers a novel solution for brain revascularization when the superficial temporal artery (STA) is unavailable. This technique uses a radial artery graft to restore blood flow, preventing stroke in cases of common carotid artery (CCA) occlusion.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Cerebrovascular Disease
Background:
- Common carotid artery (CCA) occlusion compromises brain blood flow, increasing stroke risk.
- Ipsilateral superficial temporal artery (STA) may lack adequate blood flow for standard bypass.
- Complex revascularization strategies are needed when standard extracranial-intracranial (EC-IC) bypass is not feasible.
Purpose of the Study:
- To describe the novel
- Bonnet bypass
- surgical technique.
- To present a revascularization strategy for cases with unavailable ipsilateral STA donor vessels.
Main Methods:
- A radial artery interposition graft (RAIG) was used.
- The graft connected the contralateral STA to the ipsilateral middle cerebral artery (MCA).
- A skullcap groove was created to secure the graft, preventing compression and mobilization.
Main Results:
- The
- Bonnet bypass
- procedure was successfully performed.
- This technique provides a viable revascularization option.
Conclusions:
- The
- Bonnet bypass
- enables revascularization when the ipsilateral STA is unavailable.
- This method addresses a critical need in complex cerebrovascular cases.
Background:
Common carotid artery (CCA) occlusion frequently results in compromised hemodynamics of the ipsilateral hemisphere with risk of infarction but also a lack of blood flow in the ipsilateral superficial temporal artery (STA), requiring a more complex revascularization strategy than a standard extracranial-intracranial (EC-IC) bypass when indicated.
Method:
We describe the performance of a "Bonnet bypass" using a radial artery interposition graft (RAIG) from the contralateral STA to the ipsilateral middle cerebral artery (MCA). A groove is drilled in the skullcap to position the RAIG and reduce risk of mobilization and compression.
Conclusion:
The "Bonnet bypass" enables a revascularization procedure when the ipsilateral STA is not available as donor vessel.
