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Published on: October 20, 2017
Modern Appraisal of Patency and Complications in Cerebral Bypass Surgery: A Single Institution Experience
Jeffrey Farooq1, Robert S Heller2, Mohammad Hassan A Noureldine2
1Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Insights
Cerebral bypass surgery is effective for moyamoya disease, intracranial atherosclerosis, and aneurysms. Patency is higher for moyamoya and atherosclerosis, but complications were similar across indications. Intraoperative heparin and double-barrel bypass may impact outcomes.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Cerebral bypass is a critical surgical intervention for specific patient groups.
- Updated guidelines and techniques necessitate a review of cerebral bypass complications and patency.
- Evaluating outcomes informs clinical practice and improves postoperative care.
Purpose of the Study:
- To assess complication rates and graft patency for cerebral bypass in moyamoya disease, intracranial atherosclerosis, and intracranial aneurysms.
- To compare outcomes across these three primary indications for bypass surgery.
- To identify factors influencing postoperative graft patency and complication risks.
Main Methods:
- Retrospective review of perioperative notes for 175 consecutive cerebral bypass patients.
- Evaluation of clinical course and surgical complications.
- Analysis of complication rates and graft patency based on indication and surgical technique.
Main Results:
- Overall complication rates did not differ significantly between moyamoya disease (9.2%), intracranial atherosclerosis (12.3%), and intracranial aneurysms (20%).
- Graft patency was significantly higher in moyamoya disease (93.8%) and intracranial atherosclerosis (94.1%) compared to aneurysms (72.2%).
- Intraoperative heparin use (87% patency) was associated with lower patency than no heparin (99%); double-barrel bypass trended towards higher wound healing complications (15.4% vs 2.6%).
Conclusions:
- Cerebral bypass remains a highly effective treatment for moyamoya disease, intracranial atherosclerosis, and aneurysms.
- The procedure appears safer in moyamoya disease and intracranial atherosclerosis regarding graft patency.
- Further research is needed on single-barrel versus double-barrel techniques and heparin's role in complications.
Background:
Cerebral bypass is a valuable surgical technique in well-selected patient populations. Updated clinical guidelines and improved surgical techniques warrant a contemporary reevaluation of the complications and patency to inform clinical practice and enhance postoperative patient care.
Objective:
To assess the complication rates and postoperative graft patency for the 3 most common indications for bypass surgery: moyamoya disease, intracranial atherosclerosis, and intracranial aneurysms.
Methods:
Perioperative notes of 175 consecutive bypass patients at a single institution were retrospectively identified to evaluate the clinical course and complications of surgery.
Results:
The rate of total postoperative complications between moyamoya disease (9 of 98, 9.2%), intracranial atherosclerotic disease (7 of 57, 12.3%), and intracranial aneurysm (4 of 20, 20%) was not statistically different (P = .33). Immediate postoperative bypass patency was significantly higher in moyamoya disease (90 of 96, 93.8%) and intracranial atherosclerotic disease (48 of 51, 94.1%) than in intracranial aneurysm (13 of 18, 72.2%; P = .02). Intravenous heparin administration during bypass suturing was negatively associated with immediate postoperative patency (87% heparin patency vs 99% no heparin patency; P = .02). Double-barrel bypass trended toward an increased risk of wound healing complications (2 of 13, 15.4%) compared with the single-barrel bypass technique (4 of 156, 2.6%; P = .07).
Conclusion:
Cerebral bypass surgery remains an excellent surgical treatment for moyamoya disease, intracranial atherosclerosis, and intracranial aneurysms. This study suggests bypass is safer in moyamoya disease and intracranial atherosclerosis. Additional studies to clarify the risk of single-barrel vs double-barrel bypass and intraoperative heparin-stratified complications may be beneficial.
