High-flow bypass with radial artery graft followed by internal carotid artery ligation for large or giant aneurysms of cavernous or cervical portion: clinical results and cognitive performance

Abstract

High-flow bypass followed by ligation of the internal carotid artery (ICA) is an effective treatment, but the impact of abrupt occlusion of the ICA is unpredictable, especially on postoperative cognitive function. The present study evaluated the clinical results as well as cognitive performances after high-flow bypass using radial artery graft (RAG) with supportive superficial temporal artery (STA)-middle cerebral artery (MCA) bypass, followed by ICA ligation. Ten consecutive patients underwent high-flow bypass surgery for large or giant ICA aneurysms of cavernous or cervical portion. Demographics, clinical information, magnetic resonance (MR) imaging, computed tomography, digital subtraction angiography (DSA), intraoperative somatosensory evoked potentials, neuropsychological examinations including the Wechsler Adult Intelligence Scale-Third Edition and the Wechsler Memory Scale-Revised (WMS-R), and follow-up data were analyzed. The aneurysm was located on the cavernous segment in eight cases and cervical segment in two cases, and mean aneurysm size was 27.9 mm. Postoperative DSA demonstrated robust bypass flow from the external carotid artery to MCA via the RAG, and no anterograde flow into the aneurysm. No patient showed new symptoms after the operation. Follow-up clinical study and MR imaging were performed in nine patients and showed no additional ischemic lesion compared with preoperative imaging. Seven patients completed neuropsychological examinations before and after surgery. All postoperative scores except WMS-R composite memory score slightly improved. High-flow bypass followed by ICA ligation can achieve good clinical outcomes. Successful high-flow bypass using RAG with supportive STA-MCA bypass and ICA ligation does not adversely affect postoperative cognitive function.

Extracranial-Intracranial High-Flow Bypass with Internal Carotid Artery Ligation at Neck for Giant Cavernous Internal Carotid Artery Dissecting Aneurysm in a Teen Girl with Postoperative Unusual Complication of Mono-ocular Blindness: A Case Report

“…1 Successful HFB using RAG with supportive STA-MCA bypass and ICA ligation does not adversely affect postoperative cognitive function. 11 In our case, the patient became blind postoperatively on right side (no PL or PR), with normal left-sided vision. Her ophthalmoplegia recovered completely, but right-sided eye vision remained absent.…”

“…This HFB (flow from the ECA to MCA via the RAG) cures the cavernous and supraclinoidal ICA aneurysm and usually does not allow anterograde flow into the aneurysm. 11 For HFB, RAG or great saphenous vein graft is usually used. 1,7 The RA has the benefits of having a thick wall, a good size match to the M2, and providing an intermediate flow that has been proven by many authors to be ideal to the brain.…”

Atypical symptomatic bilateral spontaneous cavernous carotid aneurysm with systemic vessel wall pathology in young female: A rare case report

“…Such a hurdle can be overcome by doing insurance bypass before the main bypass procedure to improve surgical outcome as done in our patient. [910]…”

Aneurisma grande de la arteria carótida interna cavernosa bilateral. Reporte de un caso y revisión de la literatura

“…Actualmente, se han reportado varias técnicas para el tratamiento indirecto del ACC gigante. Dichas técnicas incluyen oclusión de arteria carótida interna (ligadura directa u oclusión gradual con clamp de Selverstone), bypass de la arteria temporal superficial-arteria cerebral media (ATS-ACM) con oclusión de la arteria carótida interna, atrapamiento y bypass de alto flujo con oclusión o atrapamiento de arteria carótida interna 1,16,13,14,20,21 . En 2011, Murai et al 20 , informaron ocho pacientes mayores de 70 años con ACC sintomática grande o gigante.…”