Application of extracranial-intracranial bypass for surgical treatment of complex cerebral arterial aneurysms

Abstract

To improve the results of surgical treatment of complex cerebral arterial aneurysms (CCAAs) using of modern methods and surgical correction. The analysis of surgical treatment using microsurgical revascularization in 11 patients with CCAAs was performed. AAs localization was anterior cerebral artery - anterior communicating artery (ACA-ACoA) (9.1%), internal carotid artery (ICA) (63.6%), middle cerebral artery (MCA) (27.3%). AAs were giant, fourth of them with severe thrombosis (36.4%). Hemorrhagic complications (36.4%), aneurysm mass effect exacerbation pseudotumorosis disease (54.5%), MCA occlusion in AA МСА dissection (9%) were identified. Features of revascularization techniques were included the imposition of intracranial-intracranial microanastomosis (IICMA) between A4 of ACAs with AA detachment in AA ACA-ACoA; an overlay of high-flow microanastomosis between the external carotid artery and MCA(M2) with AA detachment (n = 6); the overlay of the extracranial-intracranial microanastomosis (EICMA) between the surface temporal artery and MCA (STA-MCA) with the AA detachment by balloon-catheter (n = 1); an EICMA (STA-MCA) upon MCA occlusion in AA dissection (n = 1); superimposition of multiple IICMA between MCА(M3) and high-flow EICMA (АСА-MCА(М2)) with АА MCА deconstruction in pseudotumorrhagic complications; a microanastomosis between common CA and MCA(M2) with dissecting AА MCA(M1) detachment. Results was ranked by a modified Rankin scale. Satisfactory results of surgical treatment of CCAAs were recorded (81.8%); profound disability due to development of microanastomosis thrombosis with hemispheric cerebral ischemia (n = 1); fatal outcome (n = 1). Indications for the use of revascularization techniques in the complex cerebral AA are the high risks of endovascular treatment and the inability of standard AA clipping.