EC-IC Bypass for Giant ICA Aneurysms

Abdulrauf, Saleem I.; Cantando, John D.; Mohan, Yedathore S.; Olivera, Raul; Lebovitz, Jonathon

doi:10.1016/b978-1-4377-1785-3.00023-2

Cited by 6 publications

(6 citation statements)

References 22 publications

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“…Moreover, the use of a flow-diverting stent was rejected because of the risk of damaging perforator arteries, especially the lenticulostriate branches [25] , and the high cost of such devices that renders them unavailable within the Indian public health service. Similarly, the use of surgical techniques would have elevated risk of morbidity and mortality [26] . While comparison of the various techniques is certainly of value, we believe that the benefits of a multidisciplinary approach are more significant in terms of effectiveness and safety.…”

Section: Discussionmentioning

confidence: 99%

A case report: On middle cerebral artery aneurysm treated by coil embolization

Tonpe,

Rathod,

Shivprasad

et al. 2022

Int. J. Radiol. Diagn. Imaging

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Introduction: Cerebral aneurysm is a common cause of intracranial hemorrhage, stroke, and death. It is treated with vascular surgeries, such as artery clipping and coil embolism. However, surgery itself is a risk factor that may cause rupture of aneurysm, and leads to irreversible brain damage, and even death. Endovascular coiling is the procedure of choice to obliterate the aneurysm by a minimally invasive procedure. Patient concerns: A 68-year-old female came to our hospital with thunderclap headache and sudden loss of consciousness. Diagnosis: Non contrast CT, CT Angiography (CTA), Digital Subtraction Angiography (DSA) and 3D rotational angiography of the head shows a right Middle cerebral artery (MCA) bifurcation aneurysm arising and incorporating the origin of superior trunk of M2 and measuring 4.7 x 3.7 mm with the neck measuring 3.7 mm. There was also subarachnoid hemorrhage in the right Sylvain fissure with edema in the right temporo-parietal lobe. Interventions: Considering the size and location of this MCA aneurysm, endovascular coil embolization was performed to obliterate the aneurysm. Outcome: Post procedure, there was no abnormality detected. Six weeks after surgery, the patient's muscle tone in both upper and lower extremities were grade V. CTA confirmed no MCA aneurysm. Lessons: Therefore endovascular coiling is a safe and effective method to obliterate the aneurysm and prevent recurrence of subarachnoid aneurysm.

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Section: Discussionmentioning

confidence: 99%

A case report: On middle cerebral artery aneurysm treated by coil embolization

Tonpe,

Rathod,

Shivprasad

et al. 2022

Int. J. Radiol. Diagn. Imaging

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“…Similarly, the sole use of microsurgical techniques would have involved actions associated with elevated risk of morbidity and mortality,[1] such as revascularization of the area distal to the aneurysm to maintain brain blood flow, proximal and distal isolation of the lesion, draining the aneurysm sac, and direct clipping of the aneurysm neck in order to reconstruct the MCA while preserving the lenticulostriate branches.…”

Section: Discussionmentioning

confidence: 99%

Treatment of complex intracranial aneurysm: Case report of the simultaneous use of endovascular and microsurgical techniques

St¹,

Rv²,

Hl³

et al. 2016

Surg Neurol Int

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Background:The surgical treatment of complex intracranial aneurysms (CIAs) represents a significant challenge to the skill and expertise of the neurosurgeon. The natural history of complex cerebrovascular lesions is especially unfavorable because of the pressure effect on adjacent areas, the risk of embolism in the presence of intraluminal thrombi, and the possibility of hemorrhage through leakage or rupture of the aneurysm. The surgical strategy must be customized for each case in order to maximize the treatment effectiveness and the safety of the patient.Case Description:A 68-year-old woman presented with a 10-month history of atypical headaches but no other neurological symptoms. Computed tomography scan and digital subtraction angiography revealed an unruptured saccular aneurysm on the M1 segment of the right middle cerebral artery. The lesion was 21 mm in length in its largest diameter and with an undefined neck (extensive involvement of the walls of the afferent vessel). Craniotomy was performed in order to expose the lesion and allow microsurgical dissection of the neck of the aneurysm and its adjacent structures. A balloon catheter was navigated via the internal carotid artery to a position alongside the aneurysm neck. With the balloon fully inflated, the aneurysm was punctured and drained, and a guide clip was located at the neck of the aneurysm. Additional clips were applied using a similar procedure to ensure the exclusion of the aneurysm.Conclusion:The patient recovered without complications and complete occlusion of the CIA was confirmed on follow-up angiography. A modified Rankin score of 0 was attributed to the patient 6 months after treatment. A multidisciplinary perspective is important in planning and executing the treatment of CIAs.

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“…Результати великих серійних досліджень, які стосуються високопотокових ЕІКА, свідчать про високу реваскуляризаційну ефективність та незначну частоту ускладнень при застосуванні цієї методики. Частота інвалідизації та летальність становлять від 2,0 до 6,6 % [5,12,13]. Дослідження прохідності графтів виявили добрі результати.…”

Section: оригінальні статтіunclassified

“…Високопотокові ЕІКА широко впроваджені в клінічну практику, починаючи з 1980-х років. Нині у багатьох спеціалізованих нейрохірургічних клініках накопичений значний досвід застосування таких хірургічних втручань [5,12,13]. В Україні досвід використання високопотокових ЕІКА та ІІКА у хірургії СЦА є незначним і представлений поодинокими спостереженнями в усних доповідях на професійних конференціях.…”

Section: оригінальні статтіunclassified

Surgical revascularization (bypass surgery) in the treatment of complicated cerebral aneurysms

Мoрoз¹,

Harmatina

Скорохода

et al. 2022

Ukr. ìnterv. nejroradìol. hìr.

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The aim of surgical treatment of any cerebral aneurysm is to achieve its total exclusion from the bloodstream. Although the progress in the development and implementation of microsurgical and the latest endovascular technologies, in many cases, the treatment of complex cerebral aneurysms is not an easy task. Unsatisfactory results of the exclusion of complicated cerebral aneurysms are due to many factors, for instance: gigantic size, fusiform or dolichoectatic configuration of the cerebral aneurysm, the presence of atherosclerotic changes, anatomical features of the departure of functionally important arteries directly from the cerebral aneurysm. Such cerebral aneurysms are quite problematic both for microsurgical remodeling clipping and for endovascular exclusion. At the current stage, the introduction and use of the microanastomosis technique provides additional options and expands the possibilities of surgical treatment of complex cerebral aneurysms.Objective ‒ to analyze the possibilities and results of surgical treatment of complicated cerebral aneurysms using the technique of surgical revascularization (bypass surgery).Materials and methods. An analysis of the results of the examination and surgical treatment of 16 patients with complicated cerebral aneurysms for the period from 2016 to 2020, who were treated and operated on in the emergency vascular neurosurgery department with the X-ray operating department Romodanov Institute of Neurosurgery of NAMS of Ukraine. All patients diagnosed with complicated cerebral aneurysms had gigantic sizes. All cases of surgical intervention included placement of extra-intracranial microanastomosis or intra-intracranial anastomosis, sometimes a combination of it, to ensure normal blood supply to the vessel of complicated cerebral aneurysm that were planned to be devascularized. In 14 observations, one-time anastomosis and exclusion of complicated cerebral aneurysms were performed. In 2 observations, the first stage was an anastomosis without exclusion of the complicated cerebral aneurysms due to insufficient vascularization of the distal arterial branch for deconstructive exclusion of aneurysm.Results. Satisfactory results of surgical treatment (grade 1 and 2 of Modified Rankin Scale (MRS)) in the general group of patients were observed in 13 (81 %) patients with complicated cerebral aneurysms. Unsatisfactory results of surgical treatment occurred in 3 (19 %) observations. Profound disability (MRS grade 5) as a result of surgical treatment was recorded in 1 (6 %) patient. Cases that ended fatally occurred in 2 (13 %) observations of the total group of patients. In the group of patients with surgical revascularization and excluded complicated cerebral aneurysms, satisfactory results were observed in 13 (92.9 %) patients. Fatal results of surgical treatment were recorded in 2 patients with a hemorrhagic course of complicated cerebral aneurysms, in which surgical revascularization was performed as first stage and scheduled removal of complicated cerebral aneurysms was planned.Conclusions. The introduction and use of the microanastomosis technique expands the possibilities of surgical treatment of complicated cerebral aneurysms. Revascularization surgical interventions are highly effective in the prevention of ischemic complications when complicated cerebral aneurysms are excluded. Recommendations (indications) for revascularization should be considered in impossibility and high risks of ischemic complications during remodeling clipping or endovascular exclusion of complicated cerebral aneurysms.

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EC-IC Bypass for Giant ICA Aneurysms

Cited by 6 publications

References 22 publications

A case report: On middle cerebral artery aneurysm treated by coil embolization

A case report: On middle cerebral artery aneurysm treated by coil embolization

Treatment of complex intracranial aneurysm: Case report of the simultaneous use of endovascular and microsurgical techniques

Surgical revascularization (bypass surgery) in the treatment of complicated cerebral aneurysms

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