High-flow extracranial-intracranial bypass for complex intracranial aneurysms

Abstract

Objective To summarize the efficacy and experiences of high-flow extracranial-intracranial bypass for complex intracranial aneurysms. Methods From August 2010 to August 2015, the clinical data of 55 patients with intracranial aneurysm treated with high-flow extracranial-intracranial bypasses at the Department of Neurosurgery, Xiangya Hospital, Central South University were analyzed retrospectively. Fifteen patients conducted balloon occlusion test(BOT)before procedure, and 11 of them could not tolerate it. The grafts were the radial artery, the calf or thigh saphenous vein segment; the feeding arteries were common carotid(external))artery, maxillary artery, and superficial temporal artery trunk; the middle cerebral arteries were the blood reception arteries in anterior circulation; the posterior cerebral arteries were the blood reception arteries in posterior circulation. Results There were no death in this group of patients. The grafts of all patients were patent at day 1 after procedure. One patient had hemiplegia immediately after surgery. CT scan revealed that a small infarct was in the basal ganglia region. The muscle strength reached grade Ⅲ-Ⅳ at day 8 after surgery. The grafts(saphenous vein of the calf segment)of 2 patients were occluded at day 3 and day 4 without symptoms. The graft(radial artery)of 1 patient was occluded at day 25 after procedure. Forty-three patients were followed up for 6 months to 52 months. The grafts(saphenous veins of the calf segment)of 2 patients were occluded at 6 months after procedure without any symptoms. In 5 patients with the graft occlusion did not conduct BOT. Conclusions High-flow extracranial-intracranial bypass for the treatment of complex intracranial aneurysms is effective. All the selected feeding vessels meet the requirements of blood supply. Graft occlusion may occur early or late after surgery. As grafts, both the saphenous vein of the calf segment and radial artery are more prone to occlusion. If they are well compensated, they may not have any clinical symptoms. Key words: Cerebral revascularization; Intracranial aneurysm; High flow