Rethinking Cerebral Bypass Surgery

Rennert, Robert C.; Russin, Jonathan J.

doi:10.1016/j.nec.2022.05.004

Cited by 8 publications

(6 citation statements)

References 93 publications

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“… 4 , 12 , 13 It is a low-cost, well-tolerated compound with minimal adverse effects and is readily available worldwide. 14 However, its utility in bypass surgery has yet to be well established. It has advantages over the ICG-VAG in terms of visualization of delicate vascular structures; however, its clearance from brain tissue is slow.…”

Section: Discussionmentioning

confidence: 99%

Fluorescein videoangiography (FL-VAG) as a predictor of cerebral bypass patency

Nathal,

Degollado-García,

Rodríguez-Rubio

et al. 2024

World Neurosurgery: X

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Section: Discussionmentioning

confidence: 99%

Fluorescein videoangiography (FL-VAG) as a predictor of cerebral bypass patency

Nathal,

Degollado-García,

Rodríguez-Rubio

et al. 2024

World Neurosurgery: X

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“…Open management of complex aneurysms, in particular cerebral bypass, remains an important tool for vascular neurosurgeons (6). Combined approaches that leverage the respective advantages of open and endovascular treatments, while avoiding their risks, can also be tailored to optimize the treatment of select aneurysms.…”

Section: Introductionmentioning

confidence: 99%

Combined open revascularization and endovascular treatment of complex intracranial aneurysms: case series

et al. 2023

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Background and purposeThe treatment of complex intracranial aneurysms can be challenging with stand-alone open or endovascular techniques, particularly after rupture. A combined open and endovascular strategy can potentially limit the risk of extensive dissections with open-only techniques, and allow for aggressive definitive endovascular treatments with minimized downstream ischemic risk.Materials and methodsRetrospective, single-institution review of consecutive patients undergoing combined open revascularization and endovascular embolization/occlusion for complex intracranial aneurysms from 1/2016 to 6/2022.ResultsTen patients (4 male [40%]; mean age 51.9 ± 8.7 years) underwent combined open revascularization and endovascular treatment of intracranial aneurysms. The majority of aneurysms, 9/10 (90%), were ruptured and 8/10 (80%) were fusiform in morphology. Aneurysms of the posterior circulation represented 8/10 (80%) of the cases (vertebral artery [VA] involving the posterior inferior cerebellar artery [PICA] origin, proximal PICA or anterior inferior cerebellar artery/PICA complex, or proximal posterior cerebral artery). Revascularization strategies included intracranial-to-intracranial (IC-IC; 7/10 [70%]) and extracranial-to-intracranial (EC-IC; 3/10 [30%]) constructs, with 100% postoperative patency. Initial endovascular procedures (consisting of aneurysm/vessel sacrifice in 9/10 patients) were performed early after surgery (0.7 ± 1.5 days). In one patient, secondary endovascular vessel sacrifice was performed after an initial sub-occlusive embolization. Treatment related strokes were diagnosed in 3/10 patients (30%), largely from involved or nearby perforators. All bypasses with follow-up were patent (median 14.0, range 4–72 months). Good outcomes (defined as a Glasgow Outcomes Scale ≥4 and modified Rankin Scale ≤2) occurred in 6/10 patients (60%).ConclusionA variety of complex aneurysms not amenable to stand-alone open or endovascular techniques can be successfully treated with combined open and endovascular approaches. Recognition and preservation of perforators is critical to treatment success.

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“…Cerebral bypass remains a valuable tool for vascular neurosurgeons in the endovascular era for Moyamoya, other select steno-occlusive diseases and complex aneurysms or tumors. 1 Although rescue bypass for flow replacement in cases of iatrogenic vessel injury or occlusion requires the same technical maneuvers as other bypasses, there are often additional challenges that arise with these procedures related to acute time limitations and suboptimal surgical conditions (i.e., unscheduled cases with potentially unfamiliar staff and sequelae from evolving injuries or blood loss including brain edema and coagulopathies). Nguyen et al 2 should thus be commended for their report detailing the successful salvage extracranial-to-intracranial high-flow bypass with a radial artery interposition graft and internal carotid artery (ICA) occlusion for the treatment of acute hemispheric hypoperfusion after repeated endovascular treatment of a giant ICA terminus aneurysm.…”

mentioning

confidence: 99%