Use of Cerebral Revascularization Techniques in the Endovascular Era. Is it Still a Useful Technique?

Abstract

Cerebral revascularization (CR) was a revolutionary surgical technique first introduced by Professor Yasargil in 1967 in the treatment of cerebral ischemia's case. In the following decades, its use was subjected to several modifications and implementations, to the point that its purpose has been expanded to other several cerebrovascular diseases. In the more recent years, its use was strongly reduced because of the advancement of the endovascular techniques, which have been showed to bring a significant number of benefits and avoid the most common surgical complications; not last, these endovascular techniques reduces in a significant way the recovery length and gives an effective treatment for those patients who were not suitable for traditional surgery. In this review, the authors search the literature to analyze the cases in which such techniques is still of use for the treatment of neurovascular diseases. CR is still a useful technique in the treatment of several pathologies, among which are moyamoya disease, complex intracranial aneurysms, and skull base tumors. A good neurosurgeon should be able to master both surgical and neurovascular approach. The teaching of CR seem to be even harder since the few cases suitable to this approaches are sometimes not enough to allow a resident or a young neurosurgeon to gain experience. CR remains an important tool in neurosurgeons' armamentarium. In this review, authors analyze the role of the cerebral revascularization techniques in the contemporary era and study the pathologies for which it can be used, in particular, moyamoya disease, complex intracranial aneurysms, and skull base tumors. KeywordsCerebral revascularization . Moyamoya disease . Complex intracranial aneurysms . Skull base tumors Abbreviations STA Superficial temporal artery EC Extracranial IC Intracranial CR Cerebral revascularization ICA Internal carotid artery MCA Middle cerebral artery TIA Transient ischemic attack EDAS Encephalo-duro-arterio-synangiosis GTR Gross total resection STR Subtotal resection

Cerebral Revascularization: Boom or Doom for Neurosurgeons

“…Thus, it is important that the surgeons, mainly the young generation, continue to improve their bypass technique using laboratory training in order to have this skill in their surgical armamentarium for the cases they will encounter. [26] With deeper knowledge of cerebral ischemia and careful selection of patient's, Neurosurgeons will be able to save many precious lives. Further research and advancement in this field is required to amplify the benefits from this surgery.…”