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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Intracranial-Intracranial Bypass for Aneurysms: Quantitative Intraoperative Assessment of Flow Preservation
Matthew J Koch1, Christopher J Stapleton2, Fady T Charbel3
1Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
Insights
Quantitative intraoperative flow measurements confirm the adequacy of intracranial-intracranial (IC-IC) bypass for preserving blood flow. This technique is vital for assessing bypass patency and ensuring sufficient flow to the brain
Area of Science:
- Neurosurgery
- Vascular Surgery
- Medical Engineering
Background:
- Intraoperative flow measurement is crucial for extracranial-intracranial bypass, assessing donor adequacy via cut flow.
- Intracranial-intracranial (IC-IC) bypass presents challenges for cut flow measurement, necessitating alternative quantitative methods.
- Quantitative flow measurements can augment the assessment of IC-IC bypass constructs.
Purpose of the Study:
- To retrospectively evaluate intraoperative flow measurements in IC-IC bypass.
- To determine the adequacy of IC-IC bypass constructs in preserving cerebral blood flow.
Main Methods:
- Retrospective review of a bypass database (2001-2021) for IC-IC bypasses with intraoperative flow measurements.
- Analysis of patient demographics, bypass indications, pre/post-bypass flow measurements, and outcomes.
- Inclusion of 22 IC-IC bypasses from 21 patients.
Main Results:
- All 22 IC-IC bypasses were patent intraoperatively.
- The average postbypass/prebypass flow index was 1.15 (±0.32), with variations between end-to-end (1.22 ± 0.34) and end-to-side/side-to-side (1.11 ± 0.32) techniques.
- All patent bypasses remained patent on postoperative angiography; one occluded later without clinical impact.
Conclusions:
- IC-IC bypass remains essential for treating complex aneurysms, despite endovascular advances.
- Quantitative flow measurements demonstrate that IC-IC bypasses provide adequate flow to the recipient territory.
- Flow measurement is valuable for assessing IC-IC bypass patency and adequacy for flow preservation.
Background:
Intraoperative flow measurement has proven utility in extracranial-intracranial bypass, particularly in assessing the adequacy of donors by measurement of cut flow. The nature of intracranial-intracranial (IC-IC) bypass precludes cut flow measurement, but quantitative intraoperative flow measurements may evaluate augment assessment of the bypass.
Objective:
To retrospectively evaluate flow measurements performed in IC-IC bypass to determine the adequacy of the constructs in preserving flow.
Methods:
With institutional review board approval, we performed a retrospective review of our bypass database from 2001 to 2021 for aneurysms treated with IC-IC bypass and with intraoperative flow measurements. Patients' preoperative characteristics, bypass indications, prebypass and postbypass intraoperative flow measurements, and patient outcomes were recorded.
Results:
Of 346 bypasses, 21 cases using 22 IC-IC bypasses were included. The median age was 55 years; 13 of 21 cases were ruptured aneurysms. Aneurysms involved posterior inferior cerebellar artery (n = 7), middle cerebral artery (n = 6), distal anterior cerebral artery (n = 5), and anterior communicating artery (n = 3). Six bypasses were end-to-side (ETS), 10 were side-to-side (STS), and 6 were excisional with reanastomosis (end-to-end, ETE). Intraoperatively, 21 of the bypasses were patent; the postbypass/prebypass flow index averaged 1.15 (±0.32): ETE (n = 6) 1.22 ± 0.34 and ETS/STS bypasses (n = 15) 1.11 ± 0.32. All intraoperatively patent bypasses were patent on postoperative angiography. One occluded on delayed angiography without clinical sequelae.
Conclusion:
Despite advances in endovascular therapy, IC-IC bypass remains essential to the treatment of large and fusiform aneurysms. We demonstrate quantitatively that IC-IC donors provide adequate direct (ETE) and redistributed (STS ETS) flow to the recipient territory. Flow measurement provides valuable information regarding the patency and adequacy of IC-IC bypass for flow preservation.
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