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EC-IC bypass for cavernous carotid aneurysms: An initial experience with twelve patients.

Menon G, Jayanand S, Krishnakumar K, Nair S - Asian J Neurosurg (2014)

Bottom Line: Check angiogram revealed thrombosis of the aneurysm in all patients with a graft patency rate of 81.8%.We had one operative mortality, probably related to a leak from the anastomotic site.All the other patients had a good recovery and with a Glasgow outcome score of 5 at last follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.

ABSTRACT

Aims: Need for performing a bypass procedure prior to parent artery occlusion in patients with good cerebral vascular reserve is controversial. We analyze our experience of 12 giant internal carotid artery aneurysms treated with extracranial-intracranial (EC-IC) bypass and proximal artery occlusion.

Materials and methods: Retrospective analysis of the case records of all complex carotid aneurysms operated in our institute since January 2009.

Results: The study included eleven cavernous carotid aneurysms and one large fusiform cervical carotid aneurysm reaching the skull base. Preoperative assessment of cerebral vascular reserve was limited to Balloon test occlusion with hypotensive challenge. Eleven patients who successfully completed a Balloon test occlusion (BTO) underwent low flow superficial temporal artery to middle cerebral artery (STA-MCA) bypass, while one patient with a failed BTO underwent a high flow bypass using a saphenous vein graft. Parent artery ligation was performed in all patients following the bypass procedure. Check angiogram revealed thrombosis of the aneurysm in all patients with a graft patency rate of 81.8%. We had one operative mortality, probably related to a leak from the anastomotic site. The only patient who had a high flow bypass developed contralateral hemispheric infarcts and remained vegetative. All the other patients had a good recovery and with a Glasgow outcome score of 5 at last follow-up.

Conclusion: We feel that combining EC-IC bypass prior to parent vessel occlusion helps in reducing the risk of post operative ischemic complications especially in situations where a complete mandated cerebral blood flow studies are not feasible.

No MeSH data available.


Related in: MedlinePlus

(a-c) DSA images of a right transitional aneurysm (cavernous and supraclinoid) of the internal carotid artery. (d) CTAngioram (post operative) showing a patent high flow saphenous vein graft from the cervical ICA to middle cerebral artery. The ICA stump and the non filling of the aneurysm are also visible
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Figure 2: (a-c) DSA images of a right transitional aneurysm (cavernous and supraclinoid) of the internal carotid artery. (d) CTAngioram (post operative) showing a patent high flow saphenous vein graft from the cervical ICA to middle cerebral artery. The ICA stump and the non filling of the aneurysm are also visible

Mentions: Check angiogram revealed thrombosis of the aneurysm in all the nine cases where parent artery ligation was carried out. Graft patency was observed on check angiograms (DSA or CTA) in 9 patients [Figures 1 and 2]. Graft patency was absent in two patients, both operated in the initial part of the series. In these two patients, parent ligation was nevertheless carried out inspite of an absent flow through the graft as the patients were found to have good collaterals and adequate cerebrovascular reserve on balloon occlusion studies. In two patients, imaging evidence of diffusion restriction was seen following bypass surgery, but both these patients did not develop any corresponding clinical deficits.


EC-IC bypass for cavernous carotid aneurysms: An initial experience with twelve patients.

Menon G, Jayanand S, Krishnakumar K, Nair S - Asian J Neurosurg (2014)

(a-c) DSA images of a right transitional aneurysm (cavernous and supraclinoid) of the internal carotid artery. (d) CTAngioram (post operative) showing a patent high flow saphenous vein graft from the cervical ICA to middle cerebral artery. The ICA stump and the non filling of the aneurysm are also visible
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4129582&req=5

Figure 2: (a-c) DSA images of a right transitional aneurysm (cavernous and supraclinoid) of the internal carotid artery. (d) CTAngioram (post operative) showing a patent high flow saphenous vein graft from the cervical ICA to middle cerebral artery. The ICA stump and the non filling of the aneurysm are also visible
Mentions: Check angiogram revealed thrombosis of the aneurysm in all the nine cases where parent artery ligation was carried out. Graft patency was observed on check angiograms (DSA or CTA) in 9 patients [Figures 1 and 2]. Graft patency was absent in two patients, both operated in the initial part of the series. In these two patients, parent ligation was nevertheless carried out inspite of an absent flow through the graft as the patients were found to have good collaterals and adequate cerebrovascular reserve on balloon occlusion studies. In two patients, imaging evidence of diffusion restriction was seen following bypass surgery, but both these patients did not develop any corresponding clinical deficits.

Bottom Line: Check angiogram revealed thrombosis of the aneurysm in all patients with a graft patency rate of 81.8%.We had one operative mortality, probably related to a leak from the anastomotic site.All the other patients had a good recovery and with a Glasgow outcome score of 5 at last follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.

ABSTRACT

Aims: Need for performing a bypass procedure prior to parent artery occlusion in patients with good cerebral vascular reserve is controversial. We analyze our experience of 12 giant internal carotid artery aneurysms treated with extracranial-intracranial (EC-IC) bypass and proximal artery occlusion.

Materials and methods: Retrospective analysis of the case records of all complex carotid aneurysms operated in our institute since January 2009.

Results: The study included eleven cavernous carotid aneurysms and one large fusiform cervical carotid aneurysm reaching the skull base. Preoperative assessment of cerebral vascular reserve was limited to Balloon test occlusion with hypotensive challenge. Eleven patients who successfully completed a Balloon test occlusion (BTO) underwent low flow superficial temporal artery to middle cerebral artery (STA-MCA) bypass, while one patient with a failed BTO underwent a high flow bypass using a saphenous vein graft. Parent artery ligation was performed in all patients following the bypass procedure. Check angiogram revealed thrombosis of the aneurysm in all patients with a graft patency rate of 81.8%. We had one operative mortality, probably related to a leak from the anastomotic site. The only patient who had a high flow bypass developed contralateral hemispheric infarcts and remained vegetative. All the other patients had a good recovery and with a Glasgow outcome score of 5 at last follow-up.

Conclusion: We feel that combining EC-IC bypass prior to parent vessel occlusion helps in reducing the risk of post operative ischemic complications especially in situations where a complete mandated cerebral blood flow studies are not feasible.

No MeSH data available.


Related in: MedlinePlus