Coding cerebral bypasses: a proposed nomenclature to better describe bypass constructs and revascularization techniques

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  • 1 Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona; and
  • | 2 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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OBJECTIVE

Bypass surgery has evolved into a complex surgical art with a variety of donor arteries, recipient arteries, interpositional grafts, anastomoses, and suturing techniques. Although innovation in contemporary bypasses has increased, the literal descriptions of these new bypasses have not kept pace. The existing nomenclature that joins donor and recipient arteries with a hyphen is simplistic, underinformative, and in need of improvement. This article proposes a nomenclature that systematically incorporates anatomical and technical details with alphanumeric abbreviations and is a clear, concise, and practical “code” for bypass surgery.

METHODS

Detailed descriptions and illustrations of the proposed nomenclature, which consists of abbreviations for donor and recipient arteries, arterial segments, arteriotomies, and sides (left or right), with hyphens and parentheses to denote the arteriotomies joined in the anastomosis and brackets and other symbols for combination bypasses, are presented. The literature was searched for articles describing bypasses, and descriptive nomenclature was categorized as donor and recipient arteries (donor-recipient), donor-recipient with additional details, less detail than donor-recipient, and complete, ambiguous, or descriptive text.

RESULTS

In 483 publications, most bypass descriptions were categorized as donor-recipient (335, 69%), with superficial temporal artery–middle cerebral artery bypass described most frequently (299, 62%). Ninety-seven articles (20%) used donor-recipient descriptions with additional details, 45 (9%) were categorized as ambiguous, and none contained a complete bypass description. The authors found the proposed nomenclature to be easily applicable to the more complex bypasses reported in the literature.

CONCLUSIONS

The authors propose a comprehensive nomenclature based on segmental anatomy and additional anastomotic details that allows bypasses to be coded simply, succinctly, and accurately. This alphanumeric shorthand allows greater precision in describing bypasses and clarifying technical details, which may improve reporting in the literature and thus help to advance the field of bypass surgery.

ABBREVIATIONS

ACA = anterior cerebral artery; ACoA = anterior communicating artery; c = continuous suturing technique; CmaA = callosomarginal artery; D-R = donor-recipient; DT = descriptive text; ECA = external carotid artery; EC-IC = extracranial to intracranial; E-E = end-to-end; E-S = end-to-side; f = frontal; i = interrupted suturing technique; IC-IC = intracranial to intracranial; L = left; MCA = middle cerebral artery; MCoA = middle communicating artery; p = parietal; PcaA = pericallosal artery; PICA = posterior inferior cerebellar artery; R = right; RAG = radial artery graft; S-S = side-to-side; STA = superficial temporal artery; SVG = saphenous vein graft; t = temporal; YRAG = Y-shaped RAG; YSTA = Y-shaped STA graft; * = intraluminal suturing technique.

Illustration from Schneider et al. (pp 205–214). Copyright Elyssa Siegel. Published with permission.

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