Cerebral revascularization for aneurysms and tumors

To discuss the indications, techniques, pitfalls, complication avoidance, and management of cerebral revascularization techniques for the treatment of aneurysms and cranial base tumors.

The indications for cerebral revascularization procedures included microsurgical occlusion of a parent vessel during the treatment of aneurysms and occlusion of a major vessel during the treatment of basal tumors. The techniques discussed include arterial patch grafting, end-to-end anastomosis, side-to-side anastomosis, arterial interposition grafting, and extracranial-to-intracranial bypass grafting, using radial artery grafts or saphenous vein grafts.

During the 15-year period between 1985 and 2000, the senior author performed 24 radial artery grafts, 105 saphenous vein grafts, and 8 other revascularization procedures, among 50 patients with aneurysms and 83 patients with cranial base tumors. The overall patency rate was 95.6%. Twenty-three patients experienced a cerebral infarction; among those patients, 17 (12.5%) exhibited symptoms but the majority demonstrated considerable recovery during the follow-up period. One hundred one patients recovered to an excellent (Glasgow Outcome Scale score of 5) or good (Glasgow Outcome Scale score of 4) condition. Fifteen patients died as a result of recurrence or progression of tumors during the follow-up period. There were five perioperative deaths. For the last 35 patients, the surgical mortality rate was 0%, with all patients returning to an excellent or good condition.

Although highly specialized, these sophisticated cerebral revascularization techniques should be learned and practiced by all neurosurgeons who wish to microsurgically treat intracranial aneurysms or cranial base tumors.