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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
[Cerebral revascularization in treatment of intractable aneurysms]
Ying Mao1, Liang-fu Zhou, Dong-lei Song
1Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China. yingmaoc@online.sh.cn
Insights
Cerebral revascularization using radial artery grafts effectively treats intractable internal carotid artery aneurysms. This method offers high-flow bypass and parent vessel occlusion, leading to successful aneurysm treatment with good patient outcomes.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Cerebrovascular Disease
Context:
- Intractable and giant internal carotid artery (ICA) aneurysms pose significant treatment challenges.
- Conventional treatments may be insufficient for complex or large aneurysms.
- Cerebral revascularization offers a potential solution for managing these difficult cases.
Purpose:
- To evaluate the efficacy of cerebral revascularization in treating intractable ICA aneurysms.
- To detail the indications, surgical techniques, and outcomes of revascularization procedures.
- To assess the use of radial artery grafts for high-flow bypass in aneurysm treatment.
Summary:
- A 4-year study involved 9 radial artery grafts for intractable/giant ICA aneurysms.
- Superficial temporal artery (STA)-Radial artery (RA)-Middle cerebral artery (MCA) bypass followed by parent vessel occlusion was performed.
- Eight of nine grafts remained patent post-procedure, with successful aneurysm treatment and excellent patient outcomes.
Impact:
- Extracranial-to-intracranial bypass with parent vessel occlusion is a safe and effective treatment for intractable ICA aneurysms.
- Radial artery grafts provide high-flow revascularization with potentially fewer complications.
- Combined surgical and endovascular approaches may represent the future for complex aneurysm management.
Objective:
To evaluate the effectiveness of cerebral revascularization in the treatment of intractable aneurysms and to discuss the indications, surgical techniques, and the outcome of the revascularization.
Methods:
During the recent 4-year period, 9 radical artery grafts were performed in patients with intractable or giant internal carotid artery (ICA) aneurysms. The indications for cerebral revascularization included parent vessel occlusion during the treatment of the intractable aneurysms with poor collateral circulation or the young patients. Modified techniques were taken to use the main trunk of superficial temporal artery (STA) as donor, while M3 branches near the bifurcation of the M2 segment of the middle cerebral artery (MCA) were chosen as the recipient arteries. STA-Radial artery (RA)-MCA bypass was followed by parent vessel occlusion via chronic cervical ICA ligation or balloon occlusion.
Results:
Postoperative angiography demonstrated the patency of the grafts in eight cases. The procedure of the parent vessels occlusion was uneventful in these patients. Follow-up showed the patients were in excellent conditions after successful treatment of aneurysms. Significantly delayed filling of the graft was revealed in one patient, who could not tolerate balloon occlusion test and occlusion of parent artery failed.
Conclusions:
Extracranial-to-intracranial bypass followed by parent vessel occlusion is a safe and effective method to treat intractable ICA aneurysms. Radical artery as graft can offer high-flow revascularization with less complications. Combined surgical and endovascular treatment might be the future direction for the treatment of the difficult aneurysms.
