Computed Tomography Perfusion Imaging Study of Intracranial Complex Aneurysms Treated by Internal Maxillary Artery
Chengyin Liu1, Heju Li2, Xiang'en Shi3
1Department of Neurosurgery, Beijing Pinggu Hospital, Beijing, China.
Insights
Internal maxillary artery bypass grafting effectively restores cerebral blood flow in patients with complex intracranial aneurysms. This surgical technique ensures adequate perfusion and prevents cerebral ischemia, leading to good patient outcomes.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Extracranial to intracranial bypass surgery is utilized for complex intracranial aneurysms.
- The internal maxillary artery serves as an effective donor artery for bypass grafting.
- Quantitative analysis of cerebral blood flow perfusion post-bypass is limited.
Purpose of the Study:
- To evaluate the effectiveness of blood perfusion after internal maxillary artery bypass grafting.
- To quantitatively assess cerebral blood flow changes using computed tomography perfusion imaging.
Main Methods:
- 19 patients undergoing internal maxillary artery radial artery middle cerebral artery bypass were studied.
- Cerebral blood flow perfusion was measured pre- and post-surgery using computed tomography perfusion imaging.
- Specific surgical techniques included aneurysm trapping and parent artery occlusion.
Main Results:
- 17 out of 19 patients achieved good outcomes within 3 months post-surgery.
- A statistically significant improvement in cerebral blood volume was observed in the anterior semioval center region (P=0.001).
- Bypass vessels remained unobstructed in all selected patients.
Conclusions:
- Internal maxillary artery bypass grafting is an effective method for intracranial revascularization.
- This technique provides sufficient intracranial blood perfusion.
- Cerebral ischemia in surrounding areas is typically avoided.
Background:
Cerebral revascularization strategies through extracranial to intracranial bypass have been adopted in the management of complex intracranial aneurysms. The internal maxillary artery used as a donor in a bypass is an effective method. At present, there are few quantitative analyses of cerebral blood flow perfusion. The main focus of this study was to evaluate the effectiveness of blood perfusion after bypass grafting.
Methods:
From April 2015 to December 2017, 19 patients who underwent internal maxillary artery radial artery middle cerebral artery bypass surgery with unobstructed bypass vessels were selected. Cerebral blood flow perfusion before and after bypass surgery was quantitatively evaluated by computed tomography perfusion imaging. The cerebral blood perfusion in the region of interest was measured by computed tomography perfusion.
Results:
The aneurysms were excised after trapping in 2 cases with mass effects and neural compression. Proximal occlusion of the parent artery was performed in 9 cases of fusiform or giant dissecting aneurysms. Trapping was performed after bypass surgery in 8 cases. Within 3 months after surgery, 17 patients had good outcomes. After the hypothesis test, there was a significant difference between the preoperative △cerebral blood volume and postoperative △cerebral blood volume in the anterior area of the semioval center cross section (P = 0.001 < 0.05).
Conclusions:
The internal maxillary artery as a bypass donor is an effective method that can provide sufficient intracranial blood perfusion, and there is usually no cerebral ischemia in the surrounding area.
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