Hostname: page-component-7b7567c8c-2n9c9 Total loading time: 0 Render date: 2026-11-15T15:54:05.694Z Has data issue: false hasContentIssue false
  • English
  • Français

Revascularization for Complex Cerebral Aneurysms

Published online by Cambridge University Press:  18 February 2016

Bai-Nan Xu,
Zheng-Hui Sun,
Chen Wu,
Jin-Li Jiang,
Ding-Biao Zhou,
Xin-Guang Yu,
Garnette R. Sutherland and
Bao-Min Li
Bai-Nan Xu*
Affiliation:
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China
Zheng-Hui Sun
Affiliation:
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China
Chen Wu
Affiliation:
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China
Jin-Li Jiang
Affiliation:
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China
Ding-Biao Zhou
Affiliation:
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China
Xin-Guang Yu
Affiliation:
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China
Garnette R. Sutherland
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
Bao-Min Li
Affiliation:
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China
*
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, 28 Fuxing Rd, Haidian District, 100853, Beijing, Canada
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the 'Save PDF' action button.
Background and Purpose:

Complex cerebral aneurysms may require indirect treatment with revascularization. This manuscript describes various surgical revascularization techniques together with clinical outcomes.

Methods:

Thirty-two consecutive patients with complex cerebral aneurysm were managed from November 2005 to October 2008. Techniques used for revascularization were high-flow bypass, low-flow bypass, branch artery reimplantion, and primary reanastomosis. Physiologic and anatomic monitoring technologies, including electroencephalography, somatosensory evoked potential monitoring, microvascular doppler ultrasonography, and/or indocyanine green videoangiography were used intraoperatively to assess both brain physiology and vascular anatomy. Patient outcome was determined using the Glasgow Outcome Scale at discharge and at a mean of 12 months post operation (range 6-25 months).

Results:

Two cervical carotid aneurysms (6%) were resected followed by primary reanastomosis, 21 aneurysms (66%) were trapped following saphenous vein high-flow bypasses, five (16%) were clipped after superficial temporal or occipital artery low-flow bypasses, and four (12%) middle cerebral branch arteries were reimplanted. Of the 32 patients at discharge, 29 (91%) had a Glasgow Outcome Scale of four or five, two (6%) had severe disability, and one (3%) died.

Conclusion:

Cerebral revascularization remains an effective and reliable procedure for treatment of complex cerebral aneurysms. Low morbidity and mortality rates reflect the maturity of patient selection and surgical technique in the management of these lesions.

Information

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 5 , September 2011, pp. 712 - 718
Copyright
Copyright © Canadian Neurological Sciences Federation 2011

References

1.Lawton, MT, Hamilton, MG, Morcos, JJ, et al.Revascularization and aneurysm surgery: current techniques, indications, and outcome. Neurosurgery. 1996;38:83–92.CrossRefGoogle ScholarPubMed
2.Linskey, ME, Sekhar, LN, Horton, JA, et al.Aneurysms of the intercavernous carotid artery: a multidisciplinary approach to treatment. J Neurosurg. 1991;75:525–34.CrossRefGoogle Scholar
3.Park, EK, Ahn, JS, Kwon, do H, et al.Result of extracranial-intracranial bypass surgery in the treatment of complex intracranial aneurysms: outcomes in 15 cases. J Korean Neurosurg Soc. 2008;44:228–33.CrossRefGoogle ScholarPubMed
4.Surdell, DL, Hage, ZA, Eddleman, CS, et al.Revascularization for complex intracranial aneurysms. Neurosurg Focus. 2008; 24:E21.Google ScholarPubMed
5.Drake, CG.Giant intracranial aneurysms: experience with surgical treatment in 174 patients. Clin Neurosurg. 1979;26:12–95.CrossRefGoogle ScholarPubMed
6.Evans, JJ, Sekhar, LN, Rak, R, et al.Bypass grafting and revascularization in the management of posterior circulation aneurysms. Neurosurgery. 2004;55:1036–49.CrossRefGoogle ScholarPubMed
7.Regli, L, Piepgras, DG, Hansen, KK.Late patency of long saphenous vein bypass grafts to the anterior and posterior cerebral circulation. J Neurosurg. 1995;83:806–11.CrossRefGoogle Scholar
8.Sekhar, LN, Stimac, D, Bakir, A, et al.Reconstruction options for complex middle cerebral artery aneurysms. Neurosurgery. 2005; 56:66–74.Google ScholarPubMed
9.Steinberg, GK, Drake, CG, Peerless, SJ.Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms. Immediate results and long-term outcome in 201 patients. J Neurosurg. 1993;79:161–73.CrossRefGoogle ScholarPubMed
10.Origitano, TC, al-Mefty, O, Leonetti, JP, et al.Vascular considerations and complications in cranial base surgery. Neurosurgery. 1994;35:351–62.CrossRefGoogle ScholarPubMed
11.Ohno, K, Arai, T, Isotani, E, et al.Ischaemic complication following obliteration of unruptured cerebral aneurysms with atherosclerotic or calcified neck. Acta Neurochir (Wien). 1999; 141:699–705.CrossRefGoogle ScholarPubMed
12.Semple, PL.Traumatic aneurysms. In: Le Roux, PD, Winn, HR, Newell, DW, editors. Management of cerebral aneurysms. Philadelphia, Pennsylvania. WB Saunders Co; 2004. p. 397–407.Google Scholar
13.Ewald, CH, Kuhne, D, Hassler, WE.Bypass-surgery and coil-embolisation in the treatment of cerebral giant aneurysms. Acta Neurochir (Wien). 2000;142:731–7.CrossRefGoogle ScholarPubMed
14.Hacein-Bey, L, Connolly, ES Jr, Mayer, SA, et al.Complex intracranial aneurysms: combined operative and endovascular approaches. Neurosurgery. 1998;43:1304–12.Google ScholarPubMed
15.Lubicz, B, Francois, O, Levivier, M, et al.Preliminary experience with the enterprise stent for endovascular treatment of complex intracranial aneurysms: Potential advantages and limiting characteristics. Neurosurgery. 2008;62:1063–9.Google ScholarPubMed
16.Anson, JA, Stone, JL, Crowell, RM.Rupture of a giant carotid aneurysm after extracranial-to-intracranial bypass-surgery. Neurosurgery. 1991;28:142–7.CrossRefGoogle ScholarPubMed
17.Drake, CG, Peerless, SJ, Ferguson, GG.Hunterian proximal arterial occlusion for giant aneurysms of the carotid circulation. J Neurosurg. 1994;81:656–65.CrossRefGoogle ScholarPubMed
18.Hunt, WE, Hess, RM.Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28: 14–20.Google Scholar
19.Jennett, B, Bond, M.Assessment of outcome after severe brain damage. Lancet. 1975;161:480–4.CrossRefGoogle Scholar
20.Mohit, AA, Sekhar, LN, Natarajan, SK, et al.High-flow bypass grafts in the management of complex intracranial aneurysms. Neurosurgery. 2007 Feb;60(2 Suppl l):ONS105–22.Google ScholarPubMed
21.Quinones-Hinojosa, A, Lawton, MT.In situ bypass in the management of complex intracranial aneurysms: technique application in 13 patients. Neurosurgery . 2005;57:140–5.Google ScholarPubMed
22.Sanus, GZ, Akar, Z, Tanriverdi, T, et al.Bypass to the intracranial giant or large internal carotid artery aneurysms: superficial temporal artery to middle cerebral artery bypass re-visited. Turk Neurosurg. 2007;17:60–5.Google ScholarPubMed
23.Quinones-Hinojosa, A, Du, R, Lawton, MT.Revascularization with saphenous vein bypasses for complex intracranial aneurysms. Skull Base. 2005;15:119–32.CrossRefGoogle ScholarPubMed
24.Drake, CG.Surgical treatment of ruptured aneurysms of the basilar artery. Experience with 14 cases. J Neurosurg. 1965;23:457–73.CrossRefGoogle ScholarPubMed
25.Roski, RA, Spetzler, RF, Nulsen, FE.Late complications of carotid ligation in the treatment of intracranial aneurysms. J Neurosurg. 1981;54:583–7.CrossRefGoogle ScholarPubMed
26.Voris, HC.Complications of ligation of the internal carotid artery. J Neurosurg. 1951;8:119–31.CrossRefGoogle ScholarPubMed
27.Miller, CA, Hill, SA, Hunt, WE. “De novo” aneurysms: a clinical review. Surg Neurol. 1985;24: 173–80.CrossRefGoogle ScholarPubMed
28.Field, M, Jungreis, CA, Chengelis, N, et al.Symptomatic cavernous sinus aneurysms: management and outcome after carotid occlusion and selective cerebral revascularization. AJNR Am J Neuroradiol. 2003;24:1200–7.Google ScholarPubMed
29.Lawton, MT, Spetzler, RF.Surgical management of giant intracranial aneurysms: experience with 171 patients. Clin Neurosurg. 1995; 42:245–66.Google ScholarPubMed
30.Sekhar, LN, Chandler, JP, Alyono, D.Saphenous vein graft reconstruction of an unclippable giant basilar artery aneurysm performed with the patient under deep hypothermic circulatory arrest: technical case report. Neurosurgery. 1998;42:667–72.Google ScholarPubMed
31.Sekhar, LN, Duff, JM, Kalavakonda, C, et al.Cerebral revascularization using radial artery grafts for the treatment of complex intracranial aneurysms: techniques and outcomes for 17 patients. Neurosurgery. 2001;49:646–58.Google ScholarPubMed
32.Hoit, DA, Schirmer, CM, Malek, AM.Stent graft treatment of cerebrovascular wall defects: intermediate-term clinical and angiographic results. Neurosurgery. 2008 May;62(5 Suppl 2): ONS380–8.Google ScholarPubMed
33.Lanzino, G, Wakhloo, AK, Fessier, RD, et al.Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg. 1999;91:538–46.CrossRefGoogle ScholarPubMed
34.Burbelko, MA, Dzyak, LA, Zorin, NA, et al.Stent-graft placement for wide-neck aneurysm of the vertebrobasilar junction. AJNR Am J Neuroradiol. 2004 Apr;25(4):608–10.Google ScholarPubMed
35.Moceo, J, Snyder, KV, Albuquerque, FC, et al.Treatment of intracranial aneurysms with the Enterprise stent: a multicentre registry. J Neurosurg. 2009;110: 35–9.Google Scholar
36.Nelson, PK, Lylyk, P, Szikora, I, et al.The pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR Am J Neuroradiol. 2011;32:34–40.CrossRefGoogle ScholarPubMed
37.Klisch, J, Turk, A, Turner, R, et al.Very late thrombosis of Flow-diverting constructs after the treatment of large fusiform posterior circulation aneurysms. AJNR Am J Neuroradiol. 2011 ; 32:627–32.CrossRefGoogle ScholarPubMed
38.Streefkerk, HJ, Bremmer, JP, van Weelden, M, et al.The excimer laser-assisted nonocclusive anastomosis practice model: development and application of a tool for practicing microvascular anastomosis techniques. Neurosurgery. 2006 Feb; 58(1 Suppl):ONS 148–56.Google ScholarPubMed
39.van Doormaal, TP, van der Zwan, A, Verweij, BH, et al.Treatment of giant middle cerebral artery aneurysms with a flow replacement bypass using the excimer laser-assisted nonocclusive anastomosis technique. Neurosurgery. 2008;63:12–20.CrossRefGoogle ScholarPubMed
40.Sekhar, LN, Bucur, SD, Bank, WO, et al.Venous and arterial bypass grafts for difficult tumors, aneurysms, and occlusive vascular lesions: evolution of surgical treatment and improved graft results. Neurosurgery. 1999;44:1207–23.Google ScholarPubMed
41.Stead, LG, Bellolio, MF, Gilmore, RM, et al.Pharmacologic elevation of blood pressure for acute brain ischemia. Neurocrit Care. 2008;8:259–61.CrossRefGoogle ScholarPubMed
42.Muench, E, Horn, P, Bauhuf, C, et al.Effects of hypervolemia and hypertension on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation after subarachnoid hemorrhage. Crit Care Med. 2007;35:1844–51.CrossRefGoogle ScholarPubMed