Submandibular-infratemporal interpositional carotid artery bypass for cranial base tumors and giant aneurysms

William T. Couldwell, James K. Liu, Amin Amini, Peter Kan

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


OBJECTIVE: Cerebral revascularization is an important strategy in the surgical management of some complex cranial base tumors and unclippable aneurysms. A high-flow bypass may be necessary in planned carotid occlusion or sacrifice. The cervical-to-supraclinoid internal carotid artery bypass or cervical carotid-to-middle cerebral artery bypass are useful procedures to bypass lesions at the base of the cranium. We describe technical modifications of the submandibular-infratemporal interpositional saphenous vein (or radial artery) graft bypass technique specifically designed to avoid removal of the zygoma. METHODS: The saphenous vein or radial artery interpositional graft is tunneled through a burr hole created in the floor of the middle fossa via a submandibular-infratemporal route avoiding removal of zygoma and attachments of the masseter or temporalis muscles. RESULTS: The technique is demonstrated in one patient with removal of a malignant cavernous sinus tumor and in another patient with an unclippable giant carotid bifurcation aneurysm. CONCLUSION: The advantages of this approach include preservation of the facial anatomy and creation of a short and safe route for passage of the saphenous vein or radial artery graft.

Original languageEnglish (US)
Pages (from-to)ONS-353-ONS-359
Issue number4 SUPPL. 2
StatePublished - Oct 2006
Externally publishedYes


  • Cranial base tumor
  • Interpositional bypass
  • Radial artery
  • Revascularization
  • Saphenous vein

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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