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Place of the extra-intra-cranial-bypass in aneurysm-surgery
T H de Jong1, C A Tulleken, L Ramos
1Department of Neurosurgery, State University Hospital, Utrecht, The Netherlands.
Insights
Extracranial-intracranial bypass surgery significantly reduces the risk of cerebral ischemia during internal carotid artery ligation. This bypass procedure proved effective in preventing major complications in patients undergoing major artery ligation.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Cerebrovascular Medicine
Background:
- Ligation of the internal carotid artery (ICA) or middle cerebral artery (MCA) historically posed a high risk of cerebral ischemia.
- Predictive tests for complications before ligation were insufficient, leading to significant risks of acute or long-term cerebral ischemia.
Purpose of the Study:
- To discuss the hemodynamic principles of extracranial-intracranial (EC/IC) bypass.
- To evaluate the effect of EC/IC bypass on local cerebral blood flow.
- To assess the safety and efficacy of EC/IC bypass in preventing cerebral ischemia during ICA or MCA ligation.
Main Methods:
- Review of the hemodynamic background and cerebral blood flow effects of EC/IC bypass.
- Analysis of a series of 26 patients requiring ligation of the ICA or MCA.
- Implementation of EC/IC bypass prior to planned arterial ligation.
Main Results:
- EC/IC bypass was established in all 26 patients considered for ICA or MCA ligation.
- Ligation of the ICA was ultimately necessary in 15 patients.
- Only one major complication occurred post-ligation; other complications were minor and temporary, indicating a high safety profile.
Conclusions:
- EC/IC bypass is a crucial preventative measure against cerebral ischemia during ICA or MCA ligation.
- The procedure significantly mitigates the risks associated with major cerebral artery ligation, improving patient outcomes.
- EC/IC bypass facilitates necessary arterial ligations with a low rate of serious complications.
Abstract:
Before the use of the EC/IC-bypass, despite several tests to predict complications, ligation of the i.c.a. (e.g. in treatment of an unclippable aneurysm) offered a significant risk of cerebral ischemia, either acutely or on long term. In this article the hemodynamic background of the EC/IC-bypass as well as its probable effect on local cerebral blood flow are discussed. Next, a series of 26 patients is presented in which ligation of the i.c.a or the m.c.a. was considered. To prevent cerebral ischemia, first an EC/IC-bypass was established. After all, in 15 patients ligation of the i.c.a. was necessary. Beside one major complication the other complications after ligation were only minor and temporary.