2026 Proffered Presentations
S001: THE USE OF CEREBRAL BYPASS IN THE SURGICAL MANAGEMENT OF SKULL BASE TUMORS: A SYSTEMATIC REVIEW OF THE LITERATURE
Emal Lesha; Delaney Graham; George Michael; Camille Milton; Aruha Khan; Nickalus Khan; University of Tennessee Health Science Center
Introduction: Tumors involving the skull base often require complex surgical management. The use of vascular bypass, whether extracranial to intracranial or intracranial to intracranial, has been previously described as a management option to ensure proper cerebral perfusion or to allow gross total resection. We aim to provide an up to date review of the utilization of bypass for skull base tumors, focusing on patient characteristics, management options, and treatment outcomes
Objective: To evaluate surgical outcomes, patency rates, and post-operative complications following bypass procedure for complex skull base tumors.
Methods: A systematic review was conducted using PRISMA guidelines. PubMed, Science Direct, and Scopus databases were searched from database inception until August 4, 2024.
Results: Among the 8,323 initially identified sources, 45 were included in the final review (Figure 1), for atotal of 376 patients with mean age 47.9 years. Meningioma (44.9%) was the most common pathology, followed by nasopharyngeal carcinoma (14.9%), squamous cell carcinoma (8.2%) and chondroma/chondrosarcoma (6.4%), as shown in Table 1. The most common reason for bypass was oncologic (94.6%) to allow gross total resection, followed by vascular (5.4%), including to allow adequate perfusion or due to intraoperative vascular injury. Gross total resection was achieved in 40.4% of reported cases. The most common type of bypass was ECA-ICA (46.6%), followed by ICA-ICA (43.2%) and CCA-ICA (8.7%), as shown in Table 2. The most common bypass related complications included graft stenosis (65.1%), post-operative stroke (25.6%) and bypass occlusion (9.3%). Bypass patency was 73.6% at latest follow up, with an average time to follow up of 18.9 months.
Conclusions: Cerebrovascular bypass is a treatment modality that can be used to maximize resection of complex skull base lesions while allowing for adequate cerebral perfusion.
