CPT® Code 61711

An extracranial to intracranial anastomosis is a surgical procedure designed to enhance cerebral blood flow by creating a connection between arteries located outside the skull (extracranial) and those within the skull (intracranial). This procedure is particularly significant in cases where there is a risk of reduced blood supply to the brain, often due to arterial blockages or other vascular issues. The most common arteries involved in this procedure are the superficial temporal artery, which is typically connected to branches of the middle cerebral artery or cortical arteries, although other arterial connections may also be utilized depending on the specific clinical scenario. The surgical approach requires a craniotomy, which involves making incisions in the scalp to create flaps, followed by the drilling of burr holes in the skull. The bone between these burr holes is then carefully cut and removed to create a bone flap, allowing access to the underlying dura mater, which is subsequently opened to expose the affected intracranial artery. The donor artery, which is the artery being used to create the bypass, is also exposed during this process. In some cases, a vein graft, often harvested from the saphenous vein in the leg, may be necessary to facilitate the bypass. The procedure employs microscopic techniques to ensure precision, allowing for either a direct bypass of the obstructed artery or the use of a vein graft to create a conduit around the blockage. Intraoperative angiograms are performed to confirm the success of the anastomosis and to assess blood flow in the brain, ensuring that the newly created pathway is functioning properly before concluding the surgery. Finally, the dura is closed, the bone flap is replaced and secured, and the skin flap is sutured closed, completing the procedure.