The use of safety extra-intracranial anastomosis in the removal of meningioma of the anterior oblique process (description of the clinical case and literature review)

Introduction. The degree of invasion of meningiomas of the anterior oblique process into the main vessels of the brain directly correlates with the radicality of their removal. The creation of safety bypass arterial shunts is one of the ways to increase the radicality of operations.

Case description. A 36-year-old patient was admitted to the Regional Clinical Hospital No. 1 named after Professor S.V. Ochapovsky with a diagnosis of meningioma of the right anterior oblique process. It was decided to perform a radical removal of the tumor with the imposition of an extra-intracranial anastomosis between the radial artery of the left arm and the right middle cerebral artery. After removal of the tumor, stenosis of the internal carotid artery was revealed, and therefore a temporary extraintracranial anastomosis was converted into a permanent shunt. The control MRI showed no signs of a residual tumor, and the cerebral blood flow was not compromised. The patient was discharged in a satisfactory condition.

Discussion. The involvement of the main cerebral arteries in the tumor node reduces the radical removal of neoplasms and reduces the duration of the recurrence-free period. The creation of a bypass arterial shunt is one of the methods of cerebral revascularization in the removal of tumors of the base of the skull with invasion into the main vessels of the brain. We used a technique that allows, at the stage of tumor removal, to provide temporary retrograde perfusion of the carotid basin arteries with the forced cessation of antegrade blood flow in them, and, if necessary, to perform permanent bypass bypass surgery of various volumes of blood flow in areas of the artery affected by the tumor.

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