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Atallah O, Almealawy YF, Badary A, Hernández-Hernández A, Andrew Awuah W, Sanker V, Chaurasia B, Umana GE. An In-Depth Analysis of the Artery of Salmon: Anatomy and Neurosurgical Implications. World Neurosurg 2024; 186:133-137. [PMID: 38531474 DOI: 10.1016/j.wneu.2024.03.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Michel Salmon was a prominent person in the field of plastic surgery during the early 20th century. His pioneering work contributed significantly to our understanding of human anatomy, particularly with the identification of the artery of Salmon (AOS). The objective of this study is to thoroughly investigate the AOS by conducting a comprehensive literature review, providing insights into its anatomy and surgical implications. METHODS This review was undertaken after a thorough examination of literature encompassing papers about the AOS. Right up until January 2024, databases like PubMed, ScienceDirect, and Web of Science were explored. The search was conducted using specific terms such as "Artery of Salmon," "suboccipital artery," and "vertebral artery anatomy." An in-depth assessment was conducted to examine the anatomy, and surgical significance of the AOS. RESULTS The AOS is a branch of the V3 segment of the vertebral artery that supplies the suboccipital muscles. The ability, to identify it, is critical for distinguishing the origins of intraoperative hemorrhage. Through careful surgical intervention, the artery was able to devascularize tumors and vascular lesions. We also touched on the technical issues of its possible application in bypass operations for aneurysms of the posterior inferior cerebellar artery or vertebral artery. CONCLUSIONS The AOS is sometimes vital in neurosurgery, facilitating precise interventions and serving as a conduit in suboccipital bypass surgeries. Understanding its variations is essential for neurosurgeons, showcasing ongoing advancements in patient care.
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Affiliation(s)
- Oday Atallah
- Departement of Neurosurgery, Hannover Medical School, Hannover, Germany
| | | | - Amr Badary
- Departemnt of Neurosurgery, Klinikum Dessau, Dessau-Roßlau, Germany
| | - Alan Hernández-Hernández
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Vivek Sanker
- Department of Neurosurgery, Trivandrum Medical College, Kerala, India
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal.
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Oliveira LB, Sousa MP, Andreão FF, Prestes MZ, Palavani LB, Batista S, Koester SW, Rabelo NN, Bertani R, Welling LC, Figueiredo EG, Lawton MT. Clinical and Technical Outcomes of Intracranial-Intracranial Bypass for Treating Complex Intracranial Aneurysms: An Analysis of 255 Patients. World Neurosurg 2024:S1878-8750(24)00816-7. [PMID: 38762027 DOI: 10.1016/j.wneu.2024.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Despite the recent increase in publications centered on intracranial-intracranial (IC-IC) bypasses for complex aneurysms, there is no systematic evidence regarding their outcomes. The purpose was to assess the outcomes of patients subjected to IC-IC bypass for aneurysms. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, a systematic review was conducted. Criteria for inclusion entailed studies with a cohort of at least 4 patients having undergone IC-IC bypass for aneurysms, detailing at least one outcome, such as patency, clinical outcomes, complications, and procedure-related mortality. When the study included patients who had undergone extracranial-intracranial (EC-IC) bypass, the authors extracted the patency and clinical data to juxtapose them with the results of IC-IC. RESULTS Of the 2509 shortlisted studies, 22 met our inclusion criteria, encompassing 255 patients and 263 IC-IC bypass procedures. The IC-IC bypass procedure exhibited a patency rate of 93% (95% confidence interval [CI]: 89%-95%). The patency rate of IC-IC and EC-IC bypasses did not significantly differ (odds ratio=0.60 [95% CI: 0.18-1.96]). Concerning clinical outcomes, 91% of the IC-IC patients had positive results (95% CI: 85%-97%), with no significant disparity between the IC-IC and EC-IC groups (odds ratio=1.29 [95% CI: 0.43-3.88]). After analysis, the complication rate was 11% (95% CI: 5%-18%). Procedure-related mortality was 1% (95% CI: 0%-4%). CONCLUSIONS IC-IC bypass is valuable for the treatment of complex intracranial aneurysms, boasting high patency and positive clinical outcomes. Complications are unusual, and procedure-related mortality is minimal. Comparing IC-IC and EC-IC led to no significant differences.
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Affiliation(s)
- Leonardo B Oliveira
- Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil.
| | - Marcelo Porto Sousa
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Filipi Fim Andreão
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Milena Zadra Prestes
- Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | | | - Sávio Batista
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stefan W Koester
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Leonardo C Welling
- Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | - Eberval G Figueiredo
- Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Nounaka Y, Murai Y, Kubota A, Tsukiyama A, Matano F, Koketsu K, Morita A. Pathological Findings of Donor Vessels in Bypass Surgery. J Clin Med 2024; 13:2125. [PMID: 38610890 PMCID: PMC11012859 DOI: 10.3390/jcm13072125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background Cerebral revascularization is necessary to treat intracranial arterial stenosis caused by moyamoya disease, atherosclerosis, or large complex aneurysms. Although various donor vascular harvesting methods have been reported safe, there are no reports on the histological evaluation of donor vessels for each disease, despite the variety of diseases wherein vascular anastomosis is required. (2) Methods Pathological findings of the superficial temporal artery (STA), radial artery (RA), occipital artery (OA), and saphenous vein (SV) harvested at the institution were analyzed. Patients classified according to aneurysm, atherosclerosis, and moyamoya disease were assessed for pathological abnormalities, medical history, age, sex, smoking, and postoperative anastomosis patency. (3) Results There were 38 cases of atherosclerosis, 15 cases of moyamoya disease, and 30 cases of aneurysm in 98 donor vessels (mean age 57.2) taken after 2006. Of the 84 STA, 11 RA, 2 OA, and 1 SV arteries that were harvested, 71.4% had atherosclerosis, 11.2% had dissection, and 10.2% had inflammation. There was no significant difference in the proportion of pathological findings according to the disease. A history of hypertension is associated with atherosclerosis in donor vessels. (4) Conclusions This is the first study to histologically evaluate the pathological findings of donor vessels according to disease. The proportion of dissection findings indicative of vascular damage due to surgical manipulation was not statistically different between the different conditions.
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Affiliation(s)
- Yohei Nounaka
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Asami Kubota
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Atsushi Tsukiyama
- Department of Neurological Surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki 211-8533, Japan
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Kenta Koketsu
- Department of Neurological Surgery, Nippon Medical School Chiba Hokusou Hospital, Inzai 270-1694, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
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Chen Y, Chen P, Duan G, Li R, Li Z, Guo G. Extracranial-intracranial bypass surgery for intracranial aneurysm of the anterior cerebral circulation: A systematic review and meta-analysis. Front Neurol 2023; 14:1174088. [PMID: 37064185 PMCID: PMC10102499 DOI: 10.3389/fneur.2023.1174088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundThe safety of extracranial–intracranial (EC–IC) bypass in the management of anterior circulation intracranial aneurysms (IAs) remains to be determined. This systematic review aims to summarize the existing evidence and provide guidance for the precise management of IAs.Data sourceWe constructed search strategies and comprehensively searched Pubmed, Medline, Embase, Web of science, and Cochrane library.MethodsThis systematic review was actualized according to the PRISMA statement. We evaluated study quality using the methodological index for non-randomized study (MINORS). Effect sizes were pooled using a random-effects model. Heterogeneity between studies was assessed using the I2 test. Publication bias was assessed using the Egger's test. The registration number for this systematic review is CRD42023396730.ResultThis systematic review included a total of 21 articles, involving 915 patients. Postoperative bypass patency rate was 99% (95% CI 0.98–1.00); short-term follow-up was 98% (95% CI 0.94–1.00); long-term follow-up was 95% (95% CI 0.93–0.97). The long-term follow-up occlusion rate of saphenous vein was higher than that of radial artery (OR 6.10 95% CI 1.04–35.59). Short-term surgery-related mortality was 0.3% (95% CI 0.000–0.012); long-term follow-up was 0.4% (95% CI 0.000–0.013); The proportion of patients with a score of 0–2 on the modified Rankin Scale (mRS) during long-term follow-up was 92% (95% CI 0.86–0.98). The incidence rates of long-term follow-up complications were: ischemic 3% (95% CI 0.01–0.06); hemorrhagic 1% (95% CI 0.00–0.03); neurological deficit 1% (95% CI 0.00–0.03); other 3% (95% CI 0.01–0.06).LimitationMost of the included studies were retrospective studies. Studies reporting preoperative status were not sufficient to demonstrate postoperative improvement. Lack of sufficient subgroup information such as aneurysm rupture status.ConclusionEC–IC therapy for anterior circulation IAs has a high safety profile. Higher level of evidence is still needed to support clinical decision.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023396730, identifier: CRD42023396730.
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Affiliation(s)
- Yang Chen
- Department of Neurosurgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Pengyu Chen
- Department of Neurosurgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Guosheng Duan
- Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, China
| | - Ren Li
- Department of Neurosurgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ziao Li
- Department of Neurosurgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Geng Guo
- Department of Emergency, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- *Correspondence: Geng Guo
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Moroz V, Harmatina O, Skorokhoda I, Shakhin N, Ghanem R, Maliar U. Surgical revascularization (bypass surgery) in the treatment of complicated cerebral aneurysms. UKRAINIAN INTERVENTIONAL NEURORADIOLOGY AND SURGERY 2022. [DOI: 10.26683/2786-4855-2022-2(40)-55-71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim of surgical treatment of any cerebral aneurysm is to achieve its total exclusion from the bloodstream. Although the progress in the development and implementation of microsurgical and the latest endovascular technologies, in many cases, the treatment of complex cerebral aneurysms is not an easy task. Unsatisfactory results of the exclusion of complicated cerebral aneurysms are due to many factors, for instance: gigantic size, fusiform or dolichoectatic configuration of the cerebral aneurysm, the presence of atherosclerotic changes, anatomical features of the departure of functionally important arteries directly from the cerebral aneurysm. Such cerebral aneurysms are quite problematic both for microsurgical remodeling clipping and for endovascular exclusion. At the current stage, the introduction and use of the microanastomosis technique provides additional options and expands the possibilities of surgical treatment of complex cerebral aneurysms.Objective ‒ to analyze the possibilities and results of surgical treatment of complicated cerebral aneurysms using the technique of surgical revascularization (bypass surgery).Materials and methods. An analysis of the results of the examination and surgical treatment of 16 patients with complicated cerebral aneurysms for the period from 2016 to 2020, who were treated and operated on in the emergency vascular neurosurgery department with the X-ray operating department Romodanov Institute of Neurosurgery of NAMS of Ukraine. All patients diagnosed with complicated cerebral aneurysms had gigantic sizes. All cases of surgical intervention included placement of extra-intracranial microanastomosis or intra-intracranial anastomosis, sometimes a combination of it, to ensure normal blood supply to the vessel of complicated cerebral aneurysm that were planned to be devascularized. In 14 observations, one-time anastomosis and exclusion of complicated cerebral aneurysms were performed. In 2 observations, the first stage was an anastomosis without exclusion of the complicated cerebral aneurysms due to insufficient vascularization of the distal arterial branch for deconstructive exclusion of aneurysm.Results. Satisfactory results of surgical treatment (grade 1 and 2 of Modified Rankin Scale (MRS)) in the general group of patients were observed in 13 (81 %) patients with complicated cerebral aneurysms. Unsatisfactory results of surgical treatment occurred in 3 (19 %) observations. Profound disability (MRS grade 5) as a result of surgical treatment was recorded in 1 (6 %) patient. Cases that ended fatally occurred in 2 (13 %) observations of the total group of patients. In the group of patients with surgical revascularization and excluded complicated cerebral aneurysms, satisfactory results were observed in 13 (92.9 %) patients. Fatal results of surgical treatment were recorded in 2 patients with a hemorrhagic course of complicated cerebral aneurysms, in which surgical revascularization was performed as first stage and scheduled removal of complicated cerebral aneurysms was planned.Conclusions. The introduction and use of the microanastomosis technique expands the possibilities of surgical treatment of complicated cerebral aneurysms. Revascularization surgical interventions are highly effective in the prevention of ischemic complications when complicated cerebral aneurysms are excluded. Recommendations (indications) for revascularization should be considered in impossibility and high risks of ischemic complications during remodeling clipping or endovascular exclusion of complicated cerebral aneurysms.
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Wolfswinkel EM, Ravina K, Rennert RC, Landau M, Strickland BA, Chun A, Wlodarczyk JR, Abedi A, Carey JN, Russin JJ. Cerebral Bypass Using the Descending Branch of the Lateral Circumflex Femoral Artery: A Case Series. Oper Neurosurg (Hagerstown) 2022; 22:364-372. [DOI: 10.1227/ons.0000000000000144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
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Yamaguchi M, Kim K, Mizunari T, Ideguchi M, Koketsu K, Yokobori S, Morita A. External carotid artery-related adverse events at extra-intra cranial high flow bypass surgery using a radial artery graft. World Neurosurg 2022; 163:e655-e662. [DOI: 10.1016/j.wneu.2022.04.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
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8
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Evolution of intracranial-intracranial bypass surgery: a bibliometric analysis. World Neurosurg 2022; 162:177-182.e9. [DOI: 10.1016/j.wneu.2022.02.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 11/24/2022]
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Techniques and Long-term Outcomes of Y-shaped Autologous Dura Mater Wrap-clipping of Blood Blister-like Aneurysms. Clin Neurol Neurosurg 2022; 214:107147. [DOI: 10.1016/j.clineuro.2022.107147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/16/2022] [Accepted: 01/24/2022] [Indexed: 11/17/2022]
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10
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Reddy VP, Singh R, McLelland MD, Barpujari A, Catapano JS, Srinivasan VM, Lawton MT. Bibliometric analysis of the extracranial-intracranial bypass literature. World Neurosurg 2022; 161:198-205.e5. [DOI: 10.1016/j.wneu.2022.01.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
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Sergeev AV, Savello AV, Cherebillo VU, Kiskaev AI, Chemurzieva F. Sequential approach of internal maxillary-to-middle cerebral artery bypass and endovascular occlusion for giant middle cerebral artery aneurysm: a case report. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00288-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The combined approach to complex brain МСА aneurysm seems to be generally considered viable. Although it is fairly common, the combinations of modalities, which are suggested in different case reports, vary significantly. This case discusses a sequential approach of reconstructive microsurgery with internal maxillary-to-middle cerebral artery bypass followed by the balloon test occlusion and endovascular embolization of the aneurysm and the MCA. The combined approach together with use of maxillary artery helped minimize the intraoperative and postoperative complications.
Case presentation
A 62-year-old female with rare episodes of headache and depression revealed giant middle cerebral artery aneurysm. The patient underwent a combined operation in a hybrid operating room with no serious neurologic deficit after surgery.
Conclusions
Multimodality management in a hybrid operating room should be considered in case of complex fusiform aneurysm of MCA, which is associated with high risks of clipping. Thus, the sequential procedures will improve patient outcomes in treatment of complex МСА aneurysms.
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Daggubati LC, Padmanaban V, Church EW. Side-to-side reverse superficial temporal artery to M4 middle cerebral artery bypass for common carotid artery occlusion with bonnet collaterals: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2177. [PMID: 35854833 PMCID: PMC9245762 DOI: 10.3171/case2177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The bonnet bypass was initially described for common carotid artery occlusion. Considered a second-generation bypass, it augments intracranial perfusion with contralateral external carotid artery flow through an interposition graft running over the scalp vertex. However, the traditional first-generation low-flow superficial temporal artery (STA)-M4 middle cerebral artery (MCA) bypass may be enhanced by performing a side-to-side (S-S) bypass with an intraluminal suture technique (fourth-generation bypass) to increase perfusion through antegrade and retrograde flow. OBSERVATIONS The authors present a reimagined S-S STA-M4 bypass in the case of a patient with symptomatic common carotid occlusion, in which the ipsilateral STA filled in a reverse fashion from the contralateral external carotid branches over the scalp vertex (bonnet collaterals). By performing an S-S anastomosis, the authors were able to improve cerebral perfusion and avoid the multiple anastomosis sites of the bonnet bypass. LESSONS The patient had a good recovery with resolution of his preoperative symptoms. Follow-up angiography showed a patent bypass supplying the MCA territory through retrograde flow in the frontal and parietal limbs of the STA, converging at the anastomosis site. In this report, the authors present a new fourth-generation bypass dubbed the “S-S reverse STA-M4 MCA bypass.”
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Hurth H, Hauser TK, Haas P, Wang S, Mengel A, Tatagiba M, Ernemann U, Khan N, Roder C. Early Post-operative CT-Angiography Imaging After EC-IC Bypass Surgery in Moyamoya Patients. Front Neurol 2021; 12:655943. [PMID: 33868157 PMCID: PMC8044757 DOI: 10.3389/fneur.2021.655943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the clinical value of early post-operative computed tomographic angiography (CTA) after direct extracranial-intracranial (EC-IC) bypass surgery in moyamoya patients. Methods: A retrospective analysis of all adult moyamoya patients treated at our center from 2013 to 2019 with a direct EC-IC bypass was performed. Early post-operative CTA (within 24 h after surgery) was compared with conventional digital subtraction angiography (DSA) 6-12 months after surgery. If available, magnetic resonance time-of-flight angiography (MR-TOF) was evaluated 3 months and 6-12 months post-operatively as well. Imaging results were analyzed and compared with CTA, MR-TOF and DSA, whereat DSA was used as the final and definite modality to decide on bypass patency. Results: A total of 103 direct EC-IC bypasses in 63 moyamoya patients were analyzed. All inclusion criteria were met in 32 patients (53 direct bypasses). In 84.9% the bypass appeared definitively, in 5.7% uncertainly and in 9.4% not patent according to early post-operative CTA. MR-TOF suggested definitive bypass patency in 86.8% 3 months after surgery and in 93.5% 6-12 months after surgery. DSA 6-12 months post-operatively showed a patency in 98.1% of all bypasses. The positive predictive value (to correctly detect an occluded bypass) on post-operative CTA was 12.5%, the negative predictive value (to correctly detect a patent bypass) was 100% with a sensitivity of 100% and a specificity of 86.5%. Conclusion: Early post-operative CTA has a high predictive value to confirm the patency of a bypass. On the other hand, a high false positive rate of (according to CTA) occluded bypasses after direct EC-IC bypass surgery can be seen. This must be considered critically when initiating possible therapeutic measures.
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Affiliation(s)
- Helene Hurth
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany.,Center for Moyamoya and Cerebral Revascularization, University Hospital Tuebingen, Tuebingen, Germany
| | - Till-Karsten Hauser
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Patrick Haas
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany.,Center for Moyamoya and Cerebral Revascularization, University Hospital Tuebingen, Tuebingen, Germany
| | - Sophie Wang
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany.,Center for Moyamoya and Cerebral Revascularization, University Hospital Tuebingen, Tuebingen, Germany
| | - Annerose Mengel
- Department of Vascular Neurology, University Hospital Tuebingen, Tuebingen, Germany.,Center for Neurovascular Diseases ZNET, University Hospital Tuebingen, Tuebingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany.,Center for Moyamoya and Cerebral Revascularization, University Hospital Tuebingen, Tuebingen, Germany.,Center for Neurovascular Diseases ZNET, University Hospital Tuebingen, Tuebingen, Germany
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tuebingen, Tuebingen, Germany.,Center for Neurovascular Diseases ZNET, University Hospital Tuebingen, Tuebingen, Germany
| | - Nadia Khan
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany.,Center for Moyamoya and Cerebral Revascularization, University Hospital Tuebingen, Tuebingen, Germany.,Moyamoya Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Constantin Roder
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany.,Center for Moyamoya and Cerebral Revascularization, University Hospital Tuebingen, Tuebingen, Germany.,Center for Neurovascular Diseases ZNET, University Hospital Tuebingen, Tuebingen, Germany
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Lukyanchikov VA, Orlov EA, Oganesyan MV, Gordeeva AA, Pavliv MP. [Anatomical bases of brain revascularization: choosing an extra-intracranial bypass option]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2021; 85:120-126. [PMID: 34951769 DOI: 10.17116/neiro202185061120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Surgical brain revascularization is an important treatment for acute or chronic ischemia, intracranial aneurysms and skull base tumors. Individual anatomy of brain vessels should be clearly understood for this procedure. Variants of collateral cerebral blood flow in patients with cerebrovascular diseases depend on individual characteristics of circle of Willis and reserve mechanisms of collateral circulation. These anatomical variations require careful preoperative planning to choose the optimal revascularization option.
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Affiliation(s)
- V A Lukyanchikov
- University's Hospital of the Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Russian People's Friendship University, Moscow, Russia
| | - E A Orlov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M V Oganesyan
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A A Gordeeva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M P Pavliv
- Sechenov First Moscow State Medical University, Moscow, Russia
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15
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Ravina K, Rennert RC, Brandel MG, Strickland BA, Chun A, Lee Y, Carey JN, Russin JJ. Comparative Assessment of Extracranial-to-Intracranial and Intracranial-to-Intracranial In Situ Bypass for Complex Intracranial Aneurysm Treatment Based on Rupture Status: A Case Series. World Neurosurg 2020; 146:e122-e138. [PMID: 33075570 DOI: 10.1016/j.wneu.2020.10.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Comparative outcomes of extracranial-to-intracranial (EC-IC) and intracranial-to-intracranial (IC-IC) bypass for complex aneurysm treatment based on rupture status are not well described in the literature. In this study, we compare outcomes of EC-IC and IC-IC bypass for complex intracranial aneurysm treatment based on rupture status. METHODS A prospective neurosurgical patient database was retrospectively reviewed. Sixty-three consecutive patients with aneurysm managed with revascularization were identified between July 2014 and December 2018. RESULTS During the study period, 41 patients with aneurysm underwent EC-IC bypass (65%; 24 [58.5%] ruptured, 17 [41.5%] unruptured) and 22 patients with aneurysm underwent IC-IC bypass (34.9%; 13 [59.1%] ruptured, 9 [40.9%] unruptured). Graft spasm occurred in 4 patients (9.8%) in the EC-IC group (all ruptured aneurysms) and all anastomoses were patent on immediate postoperative imaging. Perioperative mortality occurred in 5 patients who underwent EC-IC bypass (12.2%; 3 ruptured, 2 unruptured) EC-IC and 2 patients who underwent IC-IC bypass (9.1%; both ruptured); (P = 0.709). Bypass-related complications occurred only in patients with ruptured aneurysm (2 [8.3%] in the EC-IC group and 0 [0%] in the IC-IC group; P = 0.285). For unruptured aneurysms, the overall complication rate was lower in IC-IC compared with the EC-IC group (P = 0.006). Modified Rankin Scale scores on discharge were significantly lower in IC-IC compared with EC-IC bypass for unruptured aneurysms (P = 0.008). There was a trend for shorter temporary occlusion and hospitalization times and overall better outcomes with IC-IC compared with EC-IC bypass. CONCLUSIONS Although often considered riskier than EC-IC bypass, IC-IC in situ bypass showd a favorable technical and safety profile for the treatment of complex, unruptured aneurysms.
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Affiliation(s)
- Kristine Ravina
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Robert C Rennert
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Michael G Brandel
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Ben A Strickland
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alice Chun
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yelim Lee
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Joseph N Carey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jonathan J Russin
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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van der Zwan A, Vajkoczy P, Amin-Hanjani S, Charbel FT, Welch B, Tymianski M, Kivipelto L, van Thoor S, Chakraborty S, O'Donnell D, Langer DJ. Final Results of the Prospective Multicenter Excimer Laser-Assisted High-Flow Bypass Study on the Treatment of Giant Anterior Circulation Aneurysms. Neurosurgery 2020; 87:697-703. [PMID: 31748798 DOI: 10.1093/neuros/nyz489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/28/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Both conventional bypass utilizing temporary recipient vessel occlusion and the excimer laser-assisted nonocclusive anastomosis (ELANA) bypass technique are possible strategies in the treatment of giant aneurysms. These treatments have only been studied in single institutional retrospective studies. The potential advantage of the ELANA technique is the absence of temporary occlusion of major arteries, decreasing the risk of intraoperative ischemia. OBJECTIVE To investigate the risks and potential benefits of high-flow bypass surgery for giant and complex aneurysms of the anterior cerebral circulation. In addition, the effectiveness of the ELANA bypass procedure in the treatment of these aneurysms is determined. METHODS A total of 37 patients were included in 8 vascular neurosurgical centers in the United States, Canada, and Europe. A 30-d postoperative bypass follow-up was studied by using digital subtraction angiography and/or magnetic resonance angiography and computed tomography angiography to assess patency as well as by clinical monitoring in all patients. RESULTS In 35 patients, an ELANA high-flow bypass was performed and the aneurysm treated. Four patients had remaining neurological deficits after 30 d caused by stroke (11.4%). These strokes were not related to the ELANA anastomosis device. CONCLUSION This study does not prove that the ELANA technique has an advantage over conventional bypass techniques, but it appears to be an acceptable alternative to conventional transplanted high-flow bypass in this very-difficult-to-treat patient group, especially in select patients whom cannot be bypassed using conventional means in which temporary occlusion is considered to be not recommended.
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Affiliation(s)
- Albert van der Zwan
- Department of Neurosurgery and Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - University Hospital Berlin, Berlin, Germany
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, College of Medicine, University of Illinois, Chicago, Illinois
| | - Fady T Charbel
- Department of Neurosurgery, College of Medicine, University of Illinois, Chicago, Illinois
| | - Babu Welch
- Department of Neurosurgery, University of Texas Southwestern Medical Center, The University of Texas at Dallas, Dallas, Texas
| | - Michael Tymianski
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Canada
| | - Leena Kivipelto
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | | | - Devon O'Donnell
- Department of Neurosurgery, Lenox Hill Hospital, New York, New York
| | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital, New York, New York
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17
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Nisson PL, Ding X, Tayebi Meybodi A, Palsma R, Benet A, Lawton MT. Revascularization of the Posterior Inferior Cerebellar Artery Using the Occipital Artery: A Cadaveric Study Comparing the p3 and p1 Recipient Sites. Oper Neurosurg (Hagerstown) 2020; 19:E122-E129. [PMID: 32107553 DOI: 10.1093/ons/opaa023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/01/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Revascularization of the posterior inferior cerebellar artery (PICA) is typically performed with the occipital artery (OA) as an extracranial donor. The p3 segment is the most accessible recipient site for OA-PICA bypass at its caudal loop inferior to the cerebellar tonsil, but this site may be absent or hidden due to a high-riding location. OBJECTIVE To test our hypothesis that freeing p1 PICA from its origin, transposing the recipient into a shallower position, and performing OA-p1 PICA bypass with an end-to-end anastomosis would facilitate this bypass. METHODS The OA was harvested, and a far lateral craniotomy was performed in 16 cadaveric specimens. PICA caliber and number of perforators were measured at p1 and p3 segments. OA-p3 PICA end-to-side and OA-p1 PICA end-to-end bypasses were compared. RESULTS OA-p1 PICA bypass with end-to-end anastomosis was performed in 16 specimens; whereas, OA-p3 PICA bypass with end-to-side anastomosis was performed in 11. Mean distance from OA at the occipital groove to the anastomosis site was shorter for p1 than p3 segments (30.2 vs 48.5 mm; P < .001). Median number of perforators on p1 was 1, and on p3, it was 4 (P < .001). CONCLUSION Although most OA-PICA bypasses can be performed using the p3 segment as the recipient site for an end-to-side anastomosis, a more feasible alternative to conventional OA-p3 PICA bypass in cases of high-riding caudal loops or aberrant anatomy is to free the p1 PICA, transpose it away from the lower cranial nerves, and perform an end-to-end OA-p1 PICA bypass instead.
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Affiliation(s)
- Peyton L Nisson
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.,Department of Neurosurgery, Cedar Sinai, Beverly Hills, California
| | - Xinmin Ding
- ShanXi Province People's Hospital, Yinze District, Taiyuan, China
| | - Ali Tayebi Meybodi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Ryan Palsma
- College of Medicine, University of Arizona, Tucson, Arizona
| | - Arnau Benet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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18
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Meling TR, Patet G. The role of EC-IC bypass in ICA blood blister aneurysms-a systematic review. Neurosurg Rev 2020; 44:905-914. [PMID: 32318921 PMCID: PMC8035099 DOI: 10.1007/s10143-020-01302-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023]
Abstract
To perform a systematic review of extracranial-to-intracranial (EC-IC) bypass surgery with parent vessel trapping for blood blister–like aneurysms (BBAs) of the internal carotid artery (ICA) according to PRISMA guidelines. Search of PubMed using “bypass” [all fields] and “ICA” [all fields] or “internal carotid artery” [all fields] and (“blood blister–like aneurysm” [MeSH terms]. Thirty-four original articles were identified, of which 21 were excluded (treatment not including bypass or insufficient details on complications or clinical outcomes). Thirteen articles published between 2008 and 2019 were included, totaling 98 patients, with a median of 7.5 patients per article (range 1–17). Mean age was 53.3 years (range 23–80). The main techniques were external carotid artery to middle cerebral artery (ECA-MCA) in 81% and superficial temporal artery to MCA (STA-MCA) in 19%. The most common grafts were radial artery (74%) and STA (19%). The risk of intraoperative rupture varied from 0 to 75%, with a mean of 12%. With respect to clinical outcomes, the modified Rankin Scale (mRS) was not stated in 30% of the cases. When stated, mRS was ≤ 2 in 79%, mRS was 3–5 in 10%, and 4% had mRS 6 (death). We identified only 13 articles, with no prospective studies. Outcomes were better than generally reported for ruptured aneurysms, both with respect to poor outcome (mRS > 2) and in-hospital mortality, perhaps reflecting a selection bias. In general, the data reporting quality was low, precluding any firm conclusions, but EC-IC bypass with ICA trapping may be a valid treatment option for ruptured ICA BBAs.
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Affiliation(s)
- Torstein R Meling
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland. .,Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Service de Neurochirurgie, Hôpitaux Universitaires de Genève, Rue Gabriel-Perret-Gentil 5, 1205, Genève, Switzerland. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Gildas Patet
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
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Wongsuriyanan S, Sriamornrattanakul K. Heel Suturing on the Donor Vessel prior to Arteriotomy for End-to-side Cerebrovascular Anastomoses. Asian J Neurosurg 2020; 15:230-235. [PMID: 32181210 PMCID: PMC7057860 DOI: 10.4103/ajns.ajns_241_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/20/2019] [Indexed: 11/10/2022] Open
Abstract
Microvascular anastomosis is a common procedure in cerebrovascular surgery. End-to-side anastomoses were the most common procedure for extracranial-to-intracranial bypass. Many techniques were used to reduce clamping time of the recipient vessel. The authors innovated heel suturing on the donor vessel prior to arteriotomy (HSDA) technique from the previously described double sutures on the toe and heel of the donor vessel before arteriotomy technique for end-to-side anastomosis. Forty-three end-to-side anastomoses using the HSDA technique were collected from 32 patients.
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Affiliation(s)
- Somkiat Wongsuriyanan
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Kitiporn Sriamornrattanakul
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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20
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Walcott BP, Lawton MT. Carotid artery occlusion and revascularization in the management of meningioma. HANDBOOK OF CLINICAL NEUROLOGY 2020; 170:209-216. [PMID: 32586492 DOI: 10.1016/b978-0-12-822198-3.00041-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
As the carotid artery courses through the skull base and into the subarachnoid space, it lies in close proximity to regions notorious for meningioma growth. Although infrequent, the growth of these tumors can compromise blood flow through the artery, putting the downstream territory at risk for stroke. In other scenarios, removal of these tumors sometimes requires planning to accomplish both tumor removal and revascularization in the same procedure when then the tumor invades the artery. Since revascularization (bypass surgery) is best performed on a nonemergent basis, it should be given consideration in the preoperative setting. Crisis situations related to intraoperative iatrogenic injury are managed methodically by determining the site of vessel injury and then deciding whether a primary repair or bypass procedure is necessary. The mainstays of revascularization procedures of the carotid artery include flow augmentation and flow replacement, with the superficial temporal artery and external carotid artery being the donor sites, respectively. Although tumor control or cure can be accomplished with surgical, radiosurgical, or combined methods, attention to vascular structures and ensuring blood flow preservation as part of the treatment plan is an important tenet in meningioma surgery.
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Affiliation(s)
- Brian P Walcott
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, United States
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States.
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21
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Edward Chu YL, Tsang ACO, Chun-Pong Tsang F, Lee R, Lui WM. Endovascular Intervention for Early Postoperative Stenosis of Extracranial-Intracranial Bypass Graft: Case Report and Review of the Literature. World Neurosurg 2019; 134:460-464. [PMID: 31715412 DOI: 10.1016/j.wneu.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bypass graft stenosis following extracranial-intracranial bypass surgery carries significant risks for morbidity and mortality. In case of graft failure, treatment options include surgical revision and endovascular intervention. Whereas endovascular intervention following coronary artery bypass is well established, the role of endovascular therapy in cerebral bypass conduits is rarely reported. We present a case of extracranial-intracranial bypass graft stenosis in the early postoperative period that was successfully treated by endovascular angioplasty and stenting. CASE DESCRIPTION A middle-aged patient presented with a malignant skull base tumor with internal carotid artery invasion. Extracranial-intracranial bypass surgery was performed for flow preservation before tumor removal. Autologous radial artery was used as the bypass graft conduit. Symptomatic graft stenosis was encountered in the immediate postoperative period. Treatments in the form of intra-arterial vasodilator infusion and balloon angioplasty led to only minor flow improvement. The narrowing was eventually salvaged by endovascular stenting. Good clinical and radiologic outcomes were achieved at 6-month follow-up. CONCLUSIONS Endovascular intervention is a feasible treatment option in management of graft stenosis after cerebral revascularization surgery. Our case adds evidence to the safety and role of endovascular intervention in early cerebral bypass conduit failure. In addition, endovascular stenting can be considered as a salvage option for cases that are refractory to angioplasty.
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Affiliation(s)
| | | | | | - Raymand Lee
- Department of Radiology, Queen Mary Hospital, Hong Kong, China
| | - Wai Man Lui
- Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, Hong Kong, China
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22
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Ravina K, Rennert RC, Kim PE, Strickland BA, Chun A, Russin JJ. Orphaned Middle Cerebral Artery Side-to-Side In Situ Bypass as a Favorable Alternative Approach for Complex Middle Cerebral Artery Aneurysm Treatment: A Case Series. World Neurosurg 2019; 130:e971-e987. [DOI: 10.1016/j.wneu.2019.07.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 10/26/2022]
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23
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Guo Y, Chen H, Chen X, Yu J. Clinical importance of the occipital artery in vascular lesions: A review of the literature. Neuroradiol J 2019; 32:366-375. [PMID: 31188082 DOI: 10.1177/1971400919857245] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The occipital artery (OA) is a critical artery in vascular lesions. However, a comprehensive review of the importance of the OA is currently lacking. In this study, we used the PubMed database to perform a review of the literature on the OA to increase our understanding of its role in vascular lesions. We also provided our typical cases to illustrate the importance of the OA. The OA has several variations. For example, it may arise from the internal carotid artery or anastomose with the vertebral artery. Therefore, the OA may provide a crucial collateral vascular supply source and should be preserved in these cases. The OA is a good donor artery. Consequently, it is used in extra- to intracranial bypasses for moyamoya disease (MMD) or aneurysms. The OA can be involved in dural arteriovenous fistula (DAVF) and is a feasible artery for the embolisation of DAVF. True aneurysms and pseudoaneurysms can occur in the OA; surgical resection and embolisation are the effective treatment approaches. Direct high-flow AVF can occur in the OA; embolisation treatment is a good option in such cases. The OA can also be involved in MMD and brain arteriovenous malformation (AVM) by forming transdural collaterals. For a patient in the prone position, if occipital and suboccipital craniotomies are performed, the OA can also be used for intraoperative angiography. In brief, the OA is a very important artery in vascular lesions.
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Affiliation(s)
- Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, PR China
| | - Hao Chen
- Department of Neurosurgery, The First Hospital of Jilin University, PR China
| | - Xuan Chen
- Department of Neurosurgery, The First Hospital of Jilin University, PR China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, PR China
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Chen C, Yang Y, Ling C, He H, Luo L, Wang H. Percutaneous transluminal angioplasty for radial artery graft stenosis after high-flow superficial temporal artery trunk to middle cerebral artery interposition bypass. Br J Neurosurg 2019:1-4. [PMID: 31174437 DOI: 10.1080/02688697.2019.1621986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Due to its higher patency rate, a radial artery graft (RAG) is used as an interposition graft for internal-external high-flow bypass more frequently than a saphenous vein graft (SAG). Nevertheless, there are still a few cases of RAG stenosis after bypass surgery. Unfortunately, these reports do not elaborate on the treatment for RAG stenosis. Here, we report the first case of severe RAG stenosis after high-flow STAt-RA-MCA bypass, which was successfully treated with PTA. We speculated that RAG stenosis is associated with the over-length and kinking of the intracranial segment of the RAG instead of vasospasm. We elaborated on the surgical procedure and treatment experience in this particular case in detail. According to our experience, PTA is a type of surgical procedure that can be considered for treating RAG stenosis after high-flow bypass. As long as the surgical procedure can be performed well according to the distance between the stenosis and the anastomosis and the characteristics of the RA tissue, PTA is able to achieve satisfactory long-term results.
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Affiliation(s)
- Chuan Chen
- a Department of Neurosurgery , Third Affiliated Hospital of Sun Yat-sen University , Guangdong , PR China
| | - Yang Yang
- b Department of Gastrointestinal Surgery , Third Affiliated Hospital of Sun Yat-sen University , Guangdong , PR China
| | - Cong Ling
- a Department of Neurosurgery , Third Affiliated Hospital of Sun Yat-sen University , Guangdong , PR China
| | - Haiyong He
- a Department of Neurosurgery , Third Affiliated Hospital of Sun Yat-sen University , Guangdong , PR China
| | - Lun Luo
- a Department of Neurosurgery , Third Affiliated Hospital of Sun Yat-sen University , Guangdong , PR China
| | - Hui Wang
- a Department of Neurosurgery , Third Affiliated Hospital of Sun Yat-sen University , Guangdong , PR China
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STA-MCA bypass following sphenoid wing meningioma resection: A case report. Int J Surg Case Rep 2019; 59:132-135. [PMID: 31136872 PMCID: PMC6536740 DOI: 10.1016/j.ijscr.2019.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/29/2019] [Accepted: 05/07/2019] [Indexed: 12/03/2022] Open
Abstract
There were a few cases of skull base tumors requiring vessel revascularization. This is the first clinical report on this issue in Vietnam. Most of the vessel revascularization cases were meningiomas. Saphenous vein graft (SVGs) was the most commonly reported graft, followed by radial artery graft (RAGs). STA-MCA bypass was a safe and helpful choice, especially the collateral vessels were present and the need for blood flow augmentation was minimal.
Introduction Sphenoid meningioma engulfed cerebral arteries has always been a challenge. To achieve a gross total resection, vessel sacrifice may be unavoidable. Presentation of case A 22-year-old man with a history of head trauma a week ago complained of a headache for one week. On examination, he was alert, denied paralysis and cranial nerves palsies. Preoperative MRI showed a hypervascular left sphenoid wing meningioma embedding left internal carotid artery and proximal segment of the middle cerebral artery. In operation, a branch of the MCA was divided when dissecting the tumor. The MCA was clipped but was still difficult to dissect vessel ends in the Sylvian fissure. We decided to extend craniotomy and did superficial temporal artery to M4 segment of MCA bypass. Then, the patient was resuscitated in surgical high dependency unit for 3 days. Surgical outcome in one year postoperative was good with KPS 90 out of 100 points and no neurological deficits. On postoperative MRA, STA-MCA bypass shown acceptable flow. Discussion There were a few cases of skull base tumors requiring vessel revascularization. Most of the revascularization cases were meningiomas. Saphenous vein graft (SVGs) was the most commonly reported graft, followed by radial artery graft (RAGs). In case of difficulty in dissecting the vessel ends due to the tumor infiltration, STA-MCA bypass was a safe and helpful choice, especially the collateral vessels were present and the need for blood flow augmentation was minimal. Conclusion STA-MCA bypass was effective surgical management for MCA injury in sphenoid wing meningioma resection.
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Hu P, Zhang HQ, Li XY, Tong XZ. Double-Barrel Superficial Temporal Artery to Proximal Middle Cerebral Artery Bypass to Treat Complex Intracranial Aneurysms: A Reliable High Blood Flow Bypass. World Neurosurg 2019; 125:e884-e890. [DOI: 10.1016/j.wneu.2019.01.203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 11/30/2022]
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27
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Chen C, Wei L, Li M, Ling C, Luo L, Guo Y, Li Z, Guo Y, Wang H. Superficial Temporal Artery Trunk-to-Middle Cerebral Artery Bypass with Short Radial Artery Interposition Graft for Symptomatic Internal Carotid Artery Occlusion. World Neurosurg 2019; 127:e268-e279. [PMID: 30898742 DOI: 10.1016/j.wneu.2019.03.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We investigated the use of high-flow superficial temporal artery trunk-to-radial artery-to-middle cerebral artery (STAt-RA-MCA) bypass to prevent ischemic stroke in patients with symptomatic internal carotid artery occlusion (SICAO). METHODS We retrospectively analyzed the data from patients with SICAO who had undergone high-flow STAt-RA-MCA bypass in our center from October 2014 to November 2017. The incidence of ischemic stroke, changes in cerebral blood flow, characteristics of perioperative complications, and related factors determining the blood flow rate in the graft were analyzed. RESULTS From October 2014 to November 2017, we treated 21 patients with SICAO using high-flow STAt-RA-MCA bypass. A total of 42 ischemic stroke events had been reported within 6 months before surgery. The ipsilateral/contralateral mean transit time (I/C MTT) ratio before surgery was 1.24 ± 0.10 (range, 1.14-1.51). During a median follow-up period of 692 days (range, 212-1114), 3 transient ischemic attacks occurred in 3 patients; 18 patients (85.7%) did not experience recurrent stroke. The patency rate of the bypass graft was 95.2% (20 of 21). The I/C MTT ratio was 1.06 ± 0.11 on postoperative day 1 in all patients and was significantly different from the preoperative I/C MTT ratio (P < 0.001). The surgical complication rate was 9.5% (2 of 21), and no reoperation was required. CONCLUSION Our results suggest that high-flow STAt-RA-MCA bypass can effectively reduce the risk of stroke in patients with SICAO. Moreover, the surgical procedure is a highly safe procedure. Further randomized controlled studies are required to draw more precise conclusions.
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Affiliation(s)
- Chuan Chen
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Lei Wei
- Department of Neurology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Manting Li
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Cong Ling
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Lun Luo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yuefei Guo
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhangyu Li
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ying Guo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Hui Wang
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
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Nurminen V, Kivipelto L, Kivisaari R, Niemelä M, Lehecka M. Bypass Surgery for Complex Internal Carotid Artery Aneurysms: 39 Consecutive Patients. World Neurosurg 2019; 126:e453-e462. [PMID: 30825624 DOI: 10.1016/j.wneu.2019.02.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Bypass surgery is a special technique used to treat complex internal carotid artery (ICA) aneurysms. The aim of this retrospective study is to provide a comprehensive description of treatment and outcome of complex ICA aneurysms at different ICA segments (cavernous, supraclinoid, ICA bifurcation) treated with bypass procedures. METHODS We identified 39 consecutive patients with 41 complex ICA aneurysms that were treated with 44 bypass procedures between 1998 and 2016. We divided the aneurysms into 3 anatomic subgroups to review our treatment strategy. All the imaging studies and medical records were reviewed for relevant information. RESULTS The aneurysm occlusion (n = 34, 83%) or flow modification (n = 5, 12%) was achieved in 39 aneurysms (95%). The long-term bypass patency rate was 68% (n = 30). Minor postoperative ischemia or hemorrhage was commonly seen (n = 20, 51%), but large-scale strokes were rare (n = 1, 3%). Preoperative dysfunction of extraocular muscles (cranial nerves III, IV, and VI) showed low-to-moderate improvement rates (20%-50%). Preoperative vision disturbance (cranial nerve II) improved seldom (22%). At the latest follow-up (mean; 51 months) 29 patients (74%) were independent (modified Rankin Scale ≤2). CONCLUSIONS Bypass surgery for complex ICA aneurysms is a feasible treatment method with an acceptable risk profile. Patients should be informed of the uncertainty related to improvement of pretreatment cranial nerve dysfunctions.
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Affiliation(s)
- Ville Nurminen
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Leena Kivipelto
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Zhang M, Horiuchi T, Nitta J, Liu R, Miyaoka Y, Nakamura T, Hongo K. Intraoperative Test Occlusion as Adjustment of Extracranial-to-Intracranial Bypass Strategy for Unclippable Giant Aneurysm of the Internal Carotid Artery. World Neurosurg 2018; 122:129-132. [PMID: 30391770 DOI: 10.1016/j.wneu.2018.10.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is still a controversy for low-flow extracranial-intracranial or high-flow extracranial-intracranial bypass with proximal occlusion in the treatment of unclippable giant internal carotid artery aneurysms. CASE DESCRIPTION A 61-year-old woman presented with a 1-month history of double vision. Neuroimages revealed an unclippable giant internal carotid artery aneurysm located from the cavernous sinus to proximal site of the posterior communicating artery. Ipsilateral A1 of the anterior cerebral artery was hypoplastic, and posterior communicating artery was patent. Intraoperative proximal test occlusion at cervical internal carotid artery under neurophysiological monitoring, instead of preoperative balloon test occlusion, was performed to assess whether low-flow bypass was sufficient. The monitoring was unchanged during test occlusion, and the aneurysm was successfully trapped without high-flow bypass. Neither ischemic lesion nor neurologic deficits were found postoperatively. CONCLUSIONS Intraoperative proximal test occlusion is useful to decide on the surgical procedure of revascularization in patients with unclippable internal carotid aneurysm.
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Affiliation(s)
- Mingzhe Zhang
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Harrison International Peace Hospital, Hebei Medical University, Hebei, China
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | | | - Raynald Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yoshinari Miyaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takuya Nakamura
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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Wolfswinkel EM, Landau MJ, Ravina K, Kokot NC, Russin JJ, Carey JN. EC-IC bypass for cerebral revascularization following skull base tumor resection: Current practices and innovations. J Surg Oncol 2018; 118:815-825. [PMID: 30196557 DOI: 10.1002/jso.25178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/05/2018] [Indexed: 11/09/2022]
Abstract
Complex skull base tumors can involve critical vessels of the head and neck. To achieve a gross total resection, vessel sacrifice may be necessary. In cases where vessel sacrifice will cause symptomatic cerebral ischemia, surgical revascularization is required. The purpose of this paper is to review cerebral revascularization for skull base tumors, the indications for these procedures, outcomes, advances, and future directions.
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Affiliation(s)
- Erik M Wolfswinkel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mark J Landau
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kristine Ravina
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Niels C Kokot
- Department of Otolaryngology- Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jonathan J Russin
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joseph N Carey
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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Cikla U, Sahin B, Hanalioglu S, Ahmed AS, Niemann D, Baskaya MK. A novel, low-cost, reusable, high-fidelity neurosurgical training simulator for cerebrovascular bypass surgery. J Neurosurg 2018; 130:1663-1671. [PMID: 29749910 DOI: 10.3171/2017.11.jns17318] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 11/14/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Cerebrovascular bypass surgery is a challenging yet important neurosurgical procedure that is performed to restore circulation in the treatment of carotid occlusive diseases, giant/complex aneurysms, and skull base tumors. It requires advanced microsurgical skills and dedicated training in microsurgical techniques. Most available training tools, however, either lack the realism of the actual bypass surgery (e.g., artificial vessel, chicken wing models) or require special facilities and regulations (e.g., cadaver, live animal, placenta models). The aim of the present study was to design a readily accessible, realistic, easy-to-build, reusable, and high-fidelity simulator to train neurosurgeons or trainees on vascular anastomosis techniques even in the operating room. METHODS The authors used an anatomical skull and brain model, artificial vessels, and a water pump to simulate both extracranial and intracranial circulations. They demonstrated the step-by-step preparation of the bypass simulator using readily available and affordable equipment and consumables. RESULTS All necessary steps of a superficial temporal artery-middle cerebral artery bypass surgery (from skin opening to skin closure) were performed on the simulator under a surgical microscope. The simulator was used by both experienced neurosurgeons and trainees. Feedback survey results from the participants of the microsurgery course suggested that the model is superior to existing microanastomosis training kits in simulating real surgery conditions (e.g., depth, blood flow, anatomical constraints) and holds promise for widespread use in neurosurgical training. CONCLUSIONS With no requirement for specialized laboratory facilities and regulations, this novel, low-cost, reusable, high-fidelity simulator can be readily constructed and used for neurosurgical training with various scenarios and modifications.
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Matsukawa H, Tanikawa R, Kamiyama H, Tsuboi T, Noda K, Ota N, Miyata S, Takeda R, Tokuda S. Graft Occlusion and Graft Size Changes in Complex Internal Carotid Artery Aneurysm Treated by Extracranial to Intracranial Bypass Using High-Flow Grafts with Therapeutic Internal Carotid Artery Occlusion. Neurosurgery 2018; 81:672-679. [PMID: 28368487 DOI: 10.1093/neuros/nyx075] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/06/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although the extracranial-to-intracranial high-flow bypass (EC-IC HFB) continues to be indispensable for complex aneurysms, the risk factors for the graft occlusion and whether the graft size changes after the bypass have not been well established. OBJECTIVE To evaluate the risk factors for the graft occlusion and to confirm whether graft diameters changed over time. METHODS The data of 75 patients who suffered from complex internal carotid artery (ICA) aneurysms and were treated by EC-IC HFB using radial artery graft (RAG) or saphenous vein graft (SVG) with therapeutic ICA occlusion were evaluated. Clinical and radiological characteristics were compared in patients with and without the graft occlusion by the log-rank test. Graft diameters measured preoperatively, postoperatively, at 6 months, and at 1 year were compared by paired t-test. RESULTS During a follow-up period (median 26.2 months), graft occlusions were seen in 4 patients (5.3%), and these were the SVGs. Only SVG was related to graft occlusion (P < .001). There was a significant increase with time in RAG diameters (preoperative, 3.1 ± 0.41 mm; postoperative, 3.6 ± 0.65 mm; 6 months, 4.3 ± 1.0 mm; 1 year, 4.4 ± 1.0 mm), while there were no significant diameter changes in SVGs. CONCLUSION The present study showed that the SVG was related to the graft occlusion and RAGs gradually enlarged. Unless Allen test is negative, RAG may be better to be used as a graft in EC-IC HFB if therapeutic ICA occlusion is needed.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Toshiyuki Tsuboi
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Shiro Miyata
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rihei Takeda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
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Silva MA, Alcedo Guardia RE, Aziz-Sultan MA, Patel NJ. Thrombectomy for late occlusion of high flow extracranial-intracranial saphenous vein bypass graft after 27 years of patency. J Neurointerv Surg 2018; 10:e27. [PMID: 29627792 DOI: 10.1136/neurintsurg-2017-013670.rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 11/04/2022]
Abstract
High flow extracranial-intracranial (EC-IC) bypass with a saphenous vein graft (SVG) has been used for more than 40 years in patients with giant aneurysms of the posterior circulation refractory to medical management, and has demonstrated high long term patency rates. We report the case of a patient treated with external carotid artery (ECA)-posterior cerebral artery SVG bypass in 1989 who presented 27 years later with paresthesias and confusion, and was found to have partial occlusion of her SVG bypass graft and a basilar occlusion. She was treated with mechanical thrombectomy of the basilar occlusion via the partially thrombosed graft, the first report of such a procedure through a high flow posterior circulation EC-IC SVG, resulting in improvement of the patient's neurologic examination. At 27 years, this is the longest reported delay in thrombosis of a high flow SVG bypass graft, highlighting the long term patency of these grafts and the feasibility of thrombectomy through occluded bypass grafts.
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Affiliation(s)
- Michael A Silva
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rodolfo E Alcedo Guardia
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohammad Ali Aziz-Sultan
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nirav J Patel
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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34
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Xin C, Zhang J, Li Z, Xiong Z, Yang B, Wu X, Wang H, Zou Y, Wu R, Zhao W, Chen J. Treatment of giant cavernous aneurysm in an elderly patient via extracranial-intracranial saphenous vein bypass graft in a hybrid operating room: A case report. Medicine (Baltimore) 2018; 97:e0295. [PMID: 29620651 PMCID: PMC5902283 DOI: 10.1097/md.0000000000010295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Extracranial-intracranial saphenous vein bypass (EC-IC SVB) remains indispensable for treating giant cavernous aneurysms. We report an unusual case of a giant cavernous aneurysm in an elderly patient treated with EC-IC SVB in a hybrid operating room. Immediately following proximal ligation of the internal carotid artery (ICA), she suffered an acute intraoperative encephalocele. PATIENT CONCERNS A 71-year-old woman had suffered from severe headache and double vision for 4 months. DIAGNOSES The woman was diagnosed with a right giant cavernous aneurysm. INTERVENTIONS She was treated with an EC-IC SVB with therapeutic ICA occlusion in the first biplane hybrid operating room in China. Just after proximal ligation of the ICA, she developed an acute encephalocele, and immediately underwent decompressive craniectomy. During the surgery she underwent 3 angiographic explorations. OUTCOMES After surgery, the aneurysm disappeared, and the graft was patent. Postoperative computed tomography and computed tomography angiography indicated a cranial defect and graft patency. LESSONS Although a hybrid operating room could improve the patency of grafts, the timing of ICA ligation for giant cavernous aneurysm via EC-IC bypass deserves further discussion. Second-stage ICA occlusion could offer an alternative for elderly patients requiring such treatment. In addition, cranial flap removal could prevent further neurologic deficits in a case of acute intraoperative encephalocele.
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35
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Silva MA, Alcedo Guardia RE, Aziz-Sultan MA, Patel NJ. Thrombectomy for late occlusion of high flow extracranial-intracranial saphenous vein bypass graft after 27 years of patency. BMJ Case Rep 2018. [PMID: 29519858 DOI: 10.1136/bcr-2017-013670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
High flow extracranial-intracranial (EC-IC) bypass with a saphenous vein graft (SVG) has been used for more than 40 years in patients with giant aneurysms of the posterior circulation refractory to medical management, and has demonstrated high long term patency rates. We report the case of a patient treated with external carotid artery (ECA)-posterior cerebral artery SVG bypass in 1989 who presented 27 years later with paresthesias and confusion, and was found to have partial occlusion of her SVG bypass graft and a basilar occlusion. She was treated with mechanical thrombectomy of the basilar occlusion via the partially thrombosed graft, the first report of such a procedure through a high flow posterior circulation EC-IC SVG, resulting in improvement of the patient's neurologic examination. At 27 years, this is the longest reported delay in thrombosis of a high flow SVG bypass graft, highlighting the long term patency of these grafts and the feasibility of thrombectomy through occluded bypass grafts.
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Affiliation(s)
- Michael A Silva
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rodolfo E Alcedo Guardia
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohammad Ali Aziz-Sultan
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nirav J Patel
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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36
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Tayebi Meybodi A, Benet A, Lawton MT. The V 3 segment of the vertebral artery as a robust donor for intracranial-to-intracranial interpositional bypasses: technique and application in 5 patients. J Neurosurg 2017; 129:691-701. [PMID: 28984522 DOI: 10.3171/2017.4.jns163195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The V3 segment of the vertebral artery (VA) has been studied in various clinical scenarios, such as in tumors of the craniovertebral junction and dissecting aneurysms. However, its use as a donor artery in cerebral revascularization procedures has not been extensively studied. In this report, the authors summarize their clinical experience in cerebral revascularization procedures using the V3 segment as a donor. A brief anatomical description of the relevant techniques is also provided.
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High-flow bypass with radial artery graft followed by internal carotid artery ligation for large or giant aneurysms of cavernous or cervical portion: clinical results and cognitive performance. Neurosurg Rev 2017; 41:655-665. [PMID: 28956204 DOI: 10.1007/s10143-017-0911-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
High-flow bypass followed by ligation of the internal carotid artery (ICA) is an effective treatment, but the impact of abrupt occlusion of the ICA is unpredictable, especially on postoperative cognitive function. The present study evaluated the clinical results as well as cognitive performances after high-flow bypass using radial artery graft (RAG) with supportive superficial temporal artery (STA)-middle cerebral artery (MCA) bypass, followed by ICA ligation. Ten consecutive patients underwent high-flow bypass surgery for large or giant ICA aneurysms of cavernous or cervical portion. Demographics, clinical information, magnetic resonance (MR) imaging, computed tomography, digital subtraction angiography (DSA), intraoperative somatosensory evoked potentials, neuropsychological examinations including the Wechsler Adult Intelligence Scale-Third Edition and the Wechsler Memory Scale-Revised (WMS-R), and follow-up data were analyzed. The aneurysm was located on the cavernous segment in eight cases and cervical segment in two cases, and mean aneurysm size was 27.9 mm. Postoperative DSA demonstrated robust bypass flow from the external carotid artery to MCA via the RAG, and no anterograde flow into the aneurysm. No patient showed new symptoms after the operation. Follow-up clinical study and MR imaging were performed in nine patients and showed no additional ischemic lesion compared with preoperative imaging. Seven patients completed neuropsychological examinations before and after surgery. All postoperative scores except WMS-R composite memory score slightly improved. High-flow bypass followed by ICA ligation can achieve good clinical outcomes. Successful high-flow bypass using RAG with supportive STA-MCA bypass and ICA ligation does not adversely affect postoperative cognitive function.
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Cherian J, Srinivasan V, Kan P, Duckworth EAM. Double-Barrel Superficial Temporal Artery-Middle Cerebral Artery Bypass: Can It Be Considered “High-Flow?”. Oper Neurosurg (Hagerstown) 2017; 14:288-294. [DOI: 10.1093/ons/opx119] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 08/09/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Traditionally, superficial temporal artery-middle cerebral artery (STA-MCA) bypass uses one STA branch. Its augmentation of flow has classically been described as “low flow.” In a double-barrel STA-MCA bypass, however, both branches of the STA are utilized. Here we hypothesize that this should not be considered “low flow.”
OBJECTIVE
To review quantitative flow data from our cases and investigate the impact of double-barrel STA-MCA bypass on total flow augmentation, and to assess whether double-barrel STA-MCA bypass might be useful in situations that traditionally demand more complex bypass strategies.
METHODS
Intraoperative flow probe measurements from STA-MCA bypass cases were retrospectively tabulated and compared. Cut flow and bypass flow measurements were, respectively, taken before and after completion of anastomoses. The higher value was labeled best observed flow (BOF).
RESULTS
We identified 21 STA-MCA bypass cases with available intraoperative flow probe measurements, of which 17 utilized double-barrel technique. Only 1 STA branch was available in 4 cases. Significantly higher average BOF was seen when utilizing 2 STA branches (69 vs 39 cc/min, P < .001). A majority (9/17) of double-barrel bypasses provided BOF ≥ 65 cc/min (120 cc/min maximum). The single branch bypass maximum BOF was 40 cc/min.
CONCLUSION
Double-barrel bypass technique significantly enhances STA-MCA flow capacity and may be useful in situations in which a high-flow bypass is needed. The 2 efferent limbs allow flexibility in distributing flow across separate at-risk territories. The method compares favorably to other descriptions of high-flow bypass without the morbidity of graft harvest or an additional cervical incision.
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Affiliation(s)
- Jacob Cherian
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Visish Srinivasan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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Ono H, Inoue T, Kunii N, Tanishima T, Tamura A, Saito I, Saito N. Giant cavernous carotid aneurysm causing pituitary dysfunction: Pituitary function recovery with high-flow bypass. Surg Neurol Int 2017; 8:180. [PMID: 28868192 PMCID: PMC5569439 DOI: 10.4103/sni.sni_178_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/13/2017] [Indexed: 11/30/2022] Open
Abstract
Background: Giant internal carotid artery (ICA) aneurysms extending into the sellar region, mimicking pituitary tumors, and causing pituitary dysfunction are relatively rare. Open surgery or endovascular treatment can treat these aneurysms, but achieving recovery of endocrine function is difficult. Case Description: A 56-year-old man presented with giant aneurysm of the ICA causing pituitary impairment, leading to disturbance of consciousness due to hyponatremia. High-flow bypass from the cervical external carotid artery to the middle cerebral artery and ligation of the ICA at the cervical portion were performed. One year after the operation, his pituitary function recovered well; he was followed up as an outpatient without hormonal replacement therapy for 8 years after the operation. Conclusion: Giant ICA aneurysm causing pituitary dysfunction is relatively rare, but it is important to consider in the differential diagnosis for hypopituitarism. Treatment with high-flow bypass using radial artery graft can achieve both prevention of aneurysm rupture and recovery of pituitary function.
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Affiliation(s)
- Hideaki Ono
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka, Japan
| | - Tomohiro Inoue
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Naoto Kunii
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Takeo Tanishima
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka, Japan
| | - Akira Tamura
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka, Japan
| | - Isamu Saito
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
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40
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Ban SP, Cho WS, Kim JE, Kim CH, Bang JS, Son YJ, Kang HS, Kwon OK, Oh CW, Han MH. Bypass Surgery for Complex Intracranial Aneurysms: 15 Years of Experience at a Single Institution and Review of Pertinent Literature. Oper Neurosurg (Hagerstown) 2017. [DOI: 10.1093/ons/opx039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Bypass surgery is a treatment option for complex intracranial aneurysms.
OBJECTIVE
To determine the utility of bypass surgery for the treatment of complex intracranial aneurysms and to review the literature on this topic.
METHODS
Sixty-two patients were included in this retrospective study. Unruptured aneurysms were dominant (80.6%), and the internal carotid artery was the most common location of the aneurysm (56.4%), followed by the middle cerebral artery (21.0%). The mean maximal diameter of the aneurysms was 20.5 ± 11.4 mm. The clinical and angiographic states were evaluated preoperatively, immediately after surgery (within 3 days) and at the last follow-up. The mean angiographic and clinical follow-up duration was 34.2 ± 38.9 and 46.5 ± 42.5 months, respectively.
RESULTS
Sixty-one patients (98.3%) underwent extracranial–intracranial bypass, and 1 underwent intracranial–intracranial bypass. At the last follow-up angiography, 58 aneurysms (93.5%) were completely obliterated and 4 were incompletely obliterated, with a graft patency of 90.3%. Surgical mortality was 0 and permanent morbidity was 8.1%. A good clinical outcome (Karnofsky Performance Scale ≥ 70 and modified Rankin Scale score ≤ 2) was achieved in 91.9% of patients (n = 57).
CONCLUSION
With a proper selection of bypass type, bypass-associated treatment can be a good alternative for patients with complex intracranial aneurysms when conventional microsurgical clipping or endovascular intervention is not feasible.
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Affiliation(s)
- Seung Pil Ban
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hyeun Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Seung Bang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Je Son
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - O-Ki Kwon
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Hee Han
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Tokugawa J, Ogura K, Yatomi K, Kudo K, Hishii M, Tanikawa R, Kamiyama H. Bipolar Cutting Method: Another Technique for Harvesting Donor Artery With Histological Investigation. Oper Neurosurg (Hagerstown) 2017; 14:16-19. [DOI: 10.1093/ons/opx086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/23/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Safe and appropriate harvesting of the donor scalp vessel is the first key procedure in any type of bypass surgery.
OBJECTIVE
To use the so-called bipolar cutting method to harvest donor arteries, in which the donor arteries are skeletonized with bipolar cautery. The surgical procedure and the preparation of the equipment of the bipolar cutting method are described. The surgical results and histological assessment are presented.
METHODS
The bipolar generator was set at 50 Malis units in the coagulation mode. Under the surgical microscope, the surrounding tissue of the donor artery was divided and coagulated with the bipolar forceps. The donor artery was completely skeletonized to provide adequate length. After the recipient artery was chosen and the anastomosis site was decided, the distal end of the donor artery was cut to the appropriate length. The remnant fragment of the donor artery was histologically investigated for any damage to the arterial wall. The specimen was cut longitudinally to observe the entire length of the arterial wall and stained with hematoxylin and eosin and elastica van Gieson.
RESULTS
A total of 30 bypass surgeries were performed and 38 histological specimens were obtained between February 2015 and June 2016. The success rate of the bypass was 96%. No arterial wall damage such as thermal injury or dissection of the wall was recognized in any of the specimens.
CONCLUSION
The bipolar cutting method is a useful and safe method for harvesting donor scalp artery.
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Affiliation(s)
- Joji Tokugawa
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kanako Ogura
- Department of Pathology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kenji Yatomi
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kentaro Kudo
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Makoto Hishii
- Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Teishinkai Hospital, Sapporo, Hokkaido, Japan
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Straus DC, Brito da Silva H, McGrath L, Levitt MR, Kim LJ, Ghodke BV, Barber JK, Sekhar LN. Cerebral Revascularization for Aneurysms in the Flow-Diverter Era. Neurosurgery 2017; 80:759-768. [DOI: 10.1093/neuros/nyx064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 04/03/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Cerebral bypass has been an important tool in the treatment of complex intracranial aneurysms. The recent advent of flow-diverting stents (FDS) has expanded the capacity for endovascular arterial reconstruction.
OBJECTIVE: We investigated how the advent of FDS has impacted the application and outcomes of cerebral bypass in the treatment of intracranial aneurysms.
METHODS: We reviewed a consecutive series of cerebral bypasses during aneurysm surgery over the course of 10 years. FDS were in active use during the last 5 years of this series. We compared the clinical characteristics, surgical technique, and outcomes of patients who required cerebral bypass for aneurysm treatment during the preflow diversion era (PreFD) with those of the postflow diversion era (PostFD).
RESULTS: We treated 1061 aneurysms in the PreFD era (from July 2005 through June 2010) and 1348 in the PostFD era (from July 2010 through June 2015). Eighty-five PreFD patients (8%) and 45 PostFD patients (3%) were treated with cerebral bypass. PreFD patients had better baseline functional status compared to PostFD patients with average preoperative modified Rankin Scale score of 0.55 in PreFD and 1.18 in PostFD.
CONCLUSION: After the introduction of FDS, cerebral bypass was performed in a lower proportion of patients with aneurysms. Patients selected for bypass in the flow-diverter era had worse preoperative modified Rankin Scale scores indicating a greater complexity of the patients. Cerebral bypass in well-selected patients and revascularization remains an important technique in vascular neurosurgery. It is also useful as a rescue technique after failed FDS treatment of aneurysms.
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Affiliation(s)
- David C. Straus
- Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington
| | - Harley Brito da Silva
- Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington
| | - Lynn McGrath
- Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington
| | - Michael R. Levitt
- Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington
- Department of Radiology, University of Washington-Harborview Medical Center, Seattle, Washington
- Department of Mechanical Engineering, University of Washington, Seattle, Washington
| | - Louis J. Kim
- Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington
- Department of Radiology, University of Washington-Harborview Medical Center, Seattle, Washington
| | - Basavaraj V. Ghodke
- Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington
- Department of Radiology, University of Washington-Harborview Medical Center, Seattle, Washington
| | - Jason K. Barber
- Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington
| | - Laligam N. Sekhar
- Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington
- Department of Radiology, University of Washington-Harborview Medical Center, Seattle, Washington
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The Valveless Saphenous Vein Graft Technique for EC-IC High-Flow Bypass: Technical Note. World Neurosurg 2016; 87:35-8. [DOI: 10.1016/j.wneu.2015.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/16/2015] [Accepted: 12/16/2015] [Indexed: 11/15/2022]
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Biswas A, Samadoni AE, Elbassiouny A, Sobh K, Hegazy A. Extracranial to intracranial by-pass anastomosis: Review of our preliminary experience from a low volume center in Egypt. Asian J Neurosurg 2015; 10:303-9. [PMID: 26425161 PMCID: PMC4558808 DOI: 10.4103/1793-5482.162711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Cerebral revascularization is a useful microsurgical technique for the treatment of steno-occlusive intracranial ischemic disease, complex intracranial aneurysms that require deliberate occlusion of a parent artery and invasive skull base tumors. We describe our preliminary experience with extracranial-to-intracranial by-passes at a low volume center; and discuss clinical indications and microsurgical techniques, challenges in comparison to large advanced referral centers. Materials and Methods: Twenty-seven patients with hemodynamic ischemia or complex aneurysms or skull base tumors were operated at Cairo University Hospitals in the period between May 2009 and June 2014. All patients operated by a low flow by-pass were operated through a superficial temporal artery to middle cerebral artery (MCA) anastomosis. All patients chosen for a high flow by-pass were operated using a radial artery graft interposed between the MCAs distally and the common or the external carotid artery proximally. Patency was confirmed at the end of surgery using appearance on the table and confirmed after surgery by transcranial color-coded duplex or computed tomography angiography. All patient data were prospectively collected and retrospectively analyzed at the end of surgery. Results: Nineteen patients (70.4%) were operated upon for flow augmentation and eight patients (29.6%) were operated upon for flow replacement. A total of 30 anastomoses were performed. All except one were patent which gives a patency rate of 96.3%. There was one death in the present series resulting from a hyperperfusion syndrome. 89.5% of patients with hemodynamic ischemia stopped having symptoms after surgery. All but one patient operated for hemodynamic ischemia showed a considerable cognitive improvement after surgery. None of the patients operated upon for flow replacement showed improvement of oculomotor nerve function in spite of adequate intraoperative decompression. All patients treated for flow replacement showed the absence of recurrence on follow-up. Conclusion: Our initial results for both low and high flow by-pass procedures in our low volume center indicate that such complex surgical procedures are possible with results comparable to those obtained in other larger referral centers throughout the world. This procedure not only represents a more definitive treatment when compared to other endovascular or radiation treatments but is also much less costly when compared to other treatment modalities.
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Affiliation(s)
- Arundhati Biswas
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - A El Samadoni
- Department of Vascular Surgery, Cairo University, Giza, Egypt
| | - Ahmed Elbassiouny
- Department of Neurology and Interventional Neurology, Ain Shams University, Cairo, Egypt
| | - Khaled Sobh
- Department of Neurology, Al-Azhar University, Cairo, Egypt
| | - Ahmed Hegazy
- Department of Neurosurgery, Cairo University, Giza, Egypt
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Britz GW, Agarwal V, Mihlon F, Ramanathan D, Agrawal A, Nimjee SM, Kaylie D. Radial Artery Bypass for Intractable Vertebrobasilar Insufficiency: Case Series and Review of the Literature. World Neurosurg 2015; 85:106-13. [PMID: 26284960 DOI: 10.1016/j.wneu.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vertebrobasilar insufficiency resulting from embolism, atherosclerosis, or arterial dissection has long been a challenge for successful management and outcomes. The main treatment options include medical therapy, angioplasty and stenting, and surgical revascularization. Unlike cardiac or peripheral vascular revascularization, large randomized trials with cerebrorevascularization have not revealed favorable outcomes. In patients who have failed maximal medical therapy, and having persistent debilitating symptomology, cerebral revascularization may still be a viable option. METHODS We report 3 patients who presented with symptoms of vertebrobasilar ischemia. The diagnosis was verified by computerized tomographic arteriography and digital subtraction angiography. RESULTS These patients subsequently underwent revascularization with a radial artery graft. We also present a comprehensive review of the literature of treatment for vertebrobasilar insufficiency. CONCLUSIONS Surgical revascularization should be considered in the posterior circulation in the rare subset of patients with VBI, who remain symptomatic despite having a protracted course of maximal medical therapy with large- and medium-sized vessel occlusions and poor collateral circulation.
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Affiliation(s)
- Gavin W Britz
- Department of Neurosurgery, Methodist Hospital, Houston, Texas, USA.
| | - Vijay Agarwal
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Frank Mihlon
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Abhishek Agrawal
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Shahid M Nimjee
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David Kaylie
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Endo H, Fujimura M, Shimizu H, Inoue T, Sato K, Niizuma K, Tominaga T. Cerebral Blood Flow after Acute Bypass with Parent Artery Trapping in Patients with Ruptured Supraclinoid Internal Carotid Artery Aneurysms. J Stroke Cerebrovasc Dis 2015. [PMID: 26194848 DOI: 10.1016/j.jstrokecerebrovasdis.2015.06.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Bypass with parent artery trapping is an alternative treatment method for ruptured internal carotid artery (ICA) aneurysms when clipping or coiling is contraindicated. However, the efficacy and safety of this strategy during the acute stage of subarachnoid hemorrhage (SAH) is undetermined. METHODS A retrospective review of 955 consecutive patients presenting SAH between 2006 and 2014 identified 17 patients with ruptured ICA aneurysms treated by bypass with parent artery trapping within 72 hours after the bleeding (bypass group). The 26 cases with ruptured posterior communicating artery aneurysms treated with clipping during the same period were defined as a control group (clipping group). Postoperative cerebral blood flow (CBF) was evaluated by single photon emission computed tomography (SPECT). We analyzed the postoperative hemodynamic status, surgical complications, and the clinical outcomes. RESULTS Postoperative rebleeding did not occur in any of the cases. CBF in the first postoperative week in the bypass group was lower than that in the clipping group (P = .0165). This CBF decrease improved in the second postoperative week and did not differ from that of the clipping group. The incidence of acute ischemic complications was significantly higher in the bypass group (P = .0284), but the incidence of delayed cerebral ischemia did not differ between the 2 groups. The incidence of favorable outcomes at 6 months was 82.4% in the bypass group and 81% in the clipping group. CONCLUSIONS Although the transient CBF decrease with acute ischemic complications should be noted, acute bypass with parent artery trapping is safe and effective for unclippable/uncoilable ruptured ICA aneurysms.
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Affiliation(s)
- Hidenori Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
| | - Miki Fujimura
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimizu
- Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Takashi Inoue
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Kenichi Sato
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Rangel-Castilla L, McDougall CG, Spetzler RF, Nakaji P. Urgent cerebral revascularization bypass surgery for iatrogenic skull base internal carotid artery injury. Neurosurgery 2015; 10 Suppl 4:640-7; discussion 647-8. [PMID: 25181433 DOI: 10.1227/neu.0000000000000529] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND When feasible, the management of iatrogenic internal carotid artery (ICA) injury during skull base surgery is mainly endovascular. OBJECTIVE To propose a cerebral revascularization procedure as a rescue option when endovascular treatment is not feasible. METHODS We retrospectively reviewed all extracranial-intracranial (EC-IC) bypass procedures performed between July 2007 and January 2014. RESULTS From 235 procedures, we identified 8 consecutive patients with iatrogenic ICA injury managed with an EC-IC bypass. Injury to the ICA occurred during an endoscopic transsphenoidal surgery (n=3), endoscopic transfacial-transmaxillary surgery (n=1), myringotomy (n=1), cavernous sinus meningioma resection (n=1), posterior communicating artery aneurysm clipping (n=1), and cavernous ICA aneurysm coiling (n=1). Endovascular management was considered first-line treatment but was not successful. All patients received a high-flow EC-IC bypass. At a mean clinical/radiographic follow-up of 19 months (range, 3-36 months), all patients had a modified Rankin Scale score of 0 or 1. All bypasses remained patent. CONCLUSION Iatrogenic injury of the skull base ICA is uncommon but can lead to lethal consequences. Many injuries can be treated with endovascular techniques. However, certain cases may still require a cerebral revascularization procedure.
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Affiliation(s)
- Leonardo Rangel-Castilla
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Uozumi Y, Okamoto S, Araki Y, Izumi T, Matsubara N, Yokoyama K, Sumitomo M, Miyachi S, Wakabayashi T. Treatment of Symptomatic Bilateral Cavernous Carotid Aneurysms: Long-term Results of 6 Cases. J Stroke Cerebrovasc Dis 2015; 24:1013-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.12.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 11/17/2022] Open
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Abstract
OBJECTIVE The objective of this work was to explore the feasibility of bypass between the maxillary artery (MA) and proximity of middle cerebral artery (MCA). METHODS Ten fixed and perfused adult cadaver heads were dissected bilaterally, 20 sides in total. The superficial temporal artery and its 2 branches were dissected, and outer diameters were measured. The MA and its branch were exposed as well as deep temporal artery; outer diameter of MA was measured. The lengths between the external carotid artery, internal carotid artery, maxillary artery, and proximal middle cerebral artery were measured. Ten healthy adults as targets (20 sides), inner diameter and blood flow dynamic parameters of the common carotid artery, external carotid artery, internal carotid artery, maxillary artery, superficial temporal artery, and its 2 branches were done with ultrasound examination. RESULTS The mean outer diameter of MA (2.60 ± 0.20 mm) was larger than that of the temporal artery trunk (1.70 ± 0.30 mm). The mean lengths of graft vessels between the internal carotid artery, external carotid artery, and the bifurcation section of MCA (171.00 ± 2.70 and 162.40 ± 2.60 mm) were longer than the mean lengths of graft vessels between MA and MCA bifurcation section (61.70 ± 1.50 mm). In adults, the mean blood flow of the second part of MA (62.70 ± 13.30 mL/min) was more than that of the 2 branches of the superficial temporal artery (15.90 ± 3.70 mL/min and 17.70 ± 4.10 ml/min). CONCLUSION Bypass between the maxillary artery and proximity of middle cerebral artery is feasible. It is a kind of effective high flow bypass with which the graft vessel is shorter and straighter than the bypass between internal carotid artery or external carotid artery and proximity of middle cerebral artery.
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Yang T, Tariq F, Chabot J, Madhok R, Sekhar LN. Cerebral Revascularization for Difficult Skull Base Tumors: A Contemporary Series of 18 Patients. World Neurosurg 2014; 82:660-71. [DOI: 10.1016/j.wneu.2013.02.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
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