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Published on: August 11, 2015
Neuroplastics approach to cerebrovascular bypass surgery: the way forward for centres with small to medium volume
Jia Xu Lim1, Cindy Siaw Lin Goh2, Rambert Guan Mou Wee3
1Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore. lim.jia.xu@sgh.com.sg.
Insights
The neuroplastics approach to cerebral bypasses significantly reduces postoperative stroke rates and length of stay. This collaborative method improves outcomes in low to medium volume centers.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Cerebral bypass procedures are technically demanding.
- Reduced caseloads in low to medium volume centers can lead to suboptimal clinical outcomes.
- A standardized approach is needed to improve learning curves and consistency.
Purpose of the Study:
- To describe the neuroplastics approach for cerebral bypasses.
- To evaluate its impact on clinical outcomes in a large retrospective series.
- To demonstrate its ability to achieve outcomes comparable to high-volume centers.
Main Methods:
- Retrospective study comparing patients undergoing bypass via neuroplastics approach (NP group) versus solo neurosurgeons (Solo group).
- Classification of bypass types: double-barrel and single-barrel.
- Comparison of technical and clinical outcomes, including postoperative stroke, bleed, patency, length of stay, and modified Rankin scale.
Main Results:
- The NP group (19 patients) had zero postoperative strokes compared to 17.8% in the Solo group (50 patients) (p=0.008).
- The NP group showed a shorter median length of stay (3 days vs. 6 days, p=0.005).
- Trends favored the NP group for reduced conversion to indirect bypass, anastomotic bleeds, and improved long-term patency and functional outcomes.
Conclusions:
- The neuroplastics approach is recommended for training and executing cerebrovascular bypasses in small to medium volume centers.
- This collaborative strategy enables the delivery of high-quality cerebral bypasses with excellent patient outcomes.
- Adoption of the neuroplastics approach can mitigate challenges associated with reduced caseloads and improve surgical proficiency.
Purpose:
Cerebral bypasses are technically challenging procedures essential in the neurosurgeon's armamentarium. Decreasing surgical indications leading to reduced caseload has resulted in less than ideal clinical outcomes, particularly in low to medium volume centres. We describe the neuroplastics approach to cerebral bypasses in the largest retrospective series to date and demonstrate how this approach has been able to smoothen the learning curve and achieve consistent outcomes approximating that of high-volume centres.
Methods:
A retrospective study was conducted. All patients who received a bypass were classified into those with bypasses performed using the neuroplastics approach (NP group) and those performed by solo neurosurgeons (Solo group). Technical outcomes and clinical outcomes were compared.
Results:
There were 19 patients in the NP group and 50 patients in the Solo group. There were 17 patients in the NP group with double-barrel bypasses and 2 with single-barrel bypasses (total of 36 direct anastomoses) and 45 patients of the Solo group with single-barrel bypasses and 5 patients with conversion to indirect bypasses. Patients in the Solo group were more likely to experience a postoperative stroke in the bypassed territory (Solo, 17.8%; NP, 0%; p = 0.008). Although not statistically significant, there was a difference in the proportion of patients with conversion to indirect bypass (Solo, 10.0%; NP, 0%), postoperative anastomotic bleed (Solo, 8.9%; NP, 0%), and long-term patency (Solo, 93.9%; NP, 100%). Patients in the NP group had a shorter median length of stay (NP, 3 [2 - 7] days; Solo, 6 [5 - 9] days; p = 0.005) and 1-year modified Rankin scale approached significance (NP, 0 [0 - 0]; Solo, 0 [0 - 2]).
Conclusion:
Our experience supports the adoption of a neuroplastics approach to the training and execution of cerebrovascular bypasses in small to medium volume centres. This collaboration allowed us to deliver cerebral bypasses to indicated patients with excellent outcomes.
