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Cinar C, Elek A, Allahverdiyev I, Ozcinar KK, Yazici AC, Kusbeci M, Ozturk E, Oran I. Comprehensive Evaluation of Serpentine Aneurysms: a Systematic Review and Meta-analysis with a Subanalysis for Treatment Approaches. Clin Neuroradiol 2024:10.1007/s00062-024-01460-w. [PMID: 39316117 DOI: 10.1007/s00062-024-01460-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 08/30/2024] [Indexed: 09/25/2024]
Abstract
PURPOSE This systematic review and meta-analysis aimed to systematically evaluate and enhance the understanding of optimal management strategies for serpentine aneurysms. METHODS A systematic search was conducted in Medline, Scopus, and Cochrane databases up to July 8, 2024, using relevant keywords. Studies included were case series, prospective or retrospective cohorts, or randomized controlled trials with data on clinical and angiographic outcomes of intracranial serpentine aneurysms. Data extraction and quality assessment were performed independently by two authors. Statistical analysis was conducted using R, with pooled estimates under a random-effects model. RESULTS Ten studies comprising 70 patients with 71 serpentine aneurysms were included. The majority (92.9%) were giant aneurysms. The overall rate of procedure-related complications was 33%, morbidity was 13%, and mortality was 13%. Good neurological outcomes were achieved in 76% of cases. For unruptured aneurysms, the complication rate was 34%, while no complications were observed in ruptured aneurysms. Comparative analysis between ruptured and unruptured aneurysms showed no significant differences in outcomes or complications. The technical success rate was 91%. Reconstructive methods showed a slightly higher rate of good neurological outcomes (77%) compared to deconstructive methods (70%), though complication rates were similar. CONCLUSION Both reconstructive and deconstructive endovascular treatments for serpentine aneurysms are effective, with high rates of good neurological outcomes and acceptable complication rates.
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Affiliation(s)
- Celal Cinar
- Department of Interventional Radiology, Faculty of Medicine, Ege University, 35100, Izmir, Turkey
| | - Alperen Elek
- Department of Interventional Radiology, Faculty of Medicine, Ege University, 35100, Izmir, Turkey.
| | | | | | - Adem C Yazici
- Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Mahmut Kusbeci
- Department of Interventional Radiology, Faculty of Medicine, Ege University, 35100, Izmir, Turkey
| | - Egemen Ozturk
- Department of Radiology, Usak Training and Research Hospital, Usak, Turkey
| | - Ismail Oran
- Department of Interventional Radiology, Faculty of Medicine, Ege University, 35100, Izmir, Turkey
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2
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Oliveira LDB, Cieslak PH, Marques GN, Batista S, Andreão FF, Palavani LB, Bocanegra-Becerra JE, Bertani R, Rabelo NN, Welling LC, Figueiredo EG. Maxillary artery utilization in subcranial-intracranial bypass procedures: a comprehensive systematic review and pooled analysis. Neurosurg Rev 2024; 47:41. [PMID: 38206429 DOI: 10.1007/s10143-023-02265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/18/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024]
Abstract
The utilization of the internal maxillary artery (IMAX) in subcranial-intracranial bypass for revascularization in complex aneurysms, tumors, or refractory ischemia shows promise. However, robust evidence concerning its outcomes is lacking. Hence, the authors embarked on a systematic review with pooled analysis to elucidate the efficacy of this approach. We systematically searched PubMed, Embase, and Web of Science databases following PRISMA guidelines. Included articles used the IMAX as a donor vessel for revascularizing an intracranial area and reported at least one of the following outcomes: patency, complications, or clinical data. Favorable outcomes were defined as the absence of neurologic deficits or improvement in the baseline condition. Complications were considered any adverse event directly related to the procedure. Out of 418 retrieved articles, 26 were included, involving 183 patients. Among them, 119 had aneurysms, 41 experienced ischemic strokes (transient or not), 2 had arterial occlusions, and 3 had neoplasia. Furthermore, 91.8% of bypasses used radial artery grafts, and 87.9% revascularized the middle cerebral artery territory. The median average follow-up period was 12 months (0.3-53.1). The post-operation patency rate was 99% (95% CI: 97-100%; I2=0%), while the patency rate at follow-up was 82% (95% CI: 68-96%; I2=77%). Complications occurred in 21% of cases (95% CI: 9-32%; I2=58%), with no significant procedure-related mortality in 0% (95% CI: 0-2%; I2=0%). Favorable outcomes were observed in 88% of patients (95% CI: 81-96%; I2=0%), and only 3% experienced ischemia (95% CI: 0-6%; I2=0%). The subcranial-intracranial bypass with the IMAX shows excellent postoperative patency and considerable favorable clinical outcomes. While complications exist, the procedure carries a minimal risk of mortality. However, long-term patency presents heterogeneous findings, warranting additional research.
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Affiliation(s)
- Leonardo de Barros Oliveira
- Department of Neurosurgery, State University of Ponta Grossa, Uvaranas Campus - General Carlos Cavalcanti Avenue, 4748, Ponta Grossa, Paraná, Brazil.
| | - Pedro Henrique Cieslak
- Department of Neurosurgery, State University of Ponta Grossa, Uvaranas Campus - General Carlos Cavalcanti Avenue, 4748, Ponta Grossa, Paraná, Brazil
| | | | - Sávio Batista
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Filipi Fim Andreão
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | - Leonardo C Welling
- Department of Neurosurgery, State University of Ponta Grossa, Uvaranas Campus - General Carlos Cavalcanti Avenue, 4748, Ponta Grossa, Paraná, Brazil
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3
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Li M, Wang X, Li S, Chen G, Ren J, Chen G, Liang J, Bao Y, Sun L. Maxillary Nerve as Landmark for Exposure of the Internal Maxillary Artery in Extracranial-Intracranial Bypass Surgery. World Neurosurg 2023; 175:e406-e412. [PMID: 37011762 DOI: 10.1016/j.wneu.2023.03.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE To establish a new method for fast exposure of the internal maxillary artery (IMA) during extracranial-intracranial bypass surgery. METHODS To explore the positional relationship between the IMA and the maxillary nerve and pterygomaxillary fissure, 11 formalin-fixed cadaveric specimens were dissected. Three bone windows of the middle fossa were created for further analysis. Then the IMA length that could be pulled up above the middle fossa was measured after different degrees of removal of bony structure. The IMA branches under each bone window were also explored in detail. RESULTS The top of the pterygomaxillary fissure was located 11.50 mm anterolateral to the foramen rotundum. The IMA could be identified just inferior to the infratemporal segment maxillary nerve in all specimens. After drilling of the first bone window, the IMA length that could be pulled above the middle fossa bone was 6.85 mm. After drilling of the second bone window and further mobilization, the IMA length that could be harvested was significantly longer (9.04 mm vs. 6.85 mm; P < 0.001). Removal of the third bone window did not significantly improve the IMA length that could be harvested. CONCLUSIONS The maxillary nerve could be used as a reliable landmark for the exposure of the IMA in the pterygopalatine fossa. With our technique, the IMA could be easily exposed and sufficiently dissected without zygomatic osteotomy and extensive middle fossa floor removal.
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Affiliation(s)
- Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shenjie Li
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Guohuan Chen
- Department of Neurosurgery, Yiyang Central Hospital, Yiyang, China
| | - Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuhai Bao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liyong Sun
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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4
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Wen Y, Gou Y, Wang B, Wang Z, Chen S, Zhang S, Zhang G, Li M, Feng W, Qi S, Wang G. Is
STA
really a low‐flow graft? A quantitative ultrasonographic study of the flow of
STA
for cerebral revascularization in
MMD
patients. CNS Neurosci Ther 2023. [PMID: 37002791 PMCID: PMC10401118 DOI: 10.1111/cns.14197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/06/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE Direct revascularization remains an important tool in the treatment of patients with Moyamoya disease (MMD). The superficial temporal artery (STA) is the most commonly used donor vessel for direct bypass, and an STA graft has traditionally been considered a low-flow graft for flow augmentation. This study aimed to quantitatively evaluate the blood flow of the STA after direct revascularization. METHODS All direct revascularization procedures performed between 2018 and 2021 by one experienced neurosurgeon were screened. Quantitative ultrasound was used to measure the flow data of the patient's bilateral parietal branch of the STA(STA-PB), the bilateral frontal branch of the STA(STA-FB), and the left radial artery. Data on the patients' basic information, Suzuki grade, Matsushima type, anastomosis type, and blood biochemical parameters were collected and analyzed using univariate and multivariate models. An MBC Scale scoring system was proposed to evaluate the recipient artery network of the middle cerebral artery (MCA) tree. The relationship between MBC Scale score and STA graft flow was statistically analyzed. RESULTS In total, 81 patients (43 males and 38 females) successfully underwent STA-MCA bypass and were included in this study. The mean flow rates in the STA-PB graft on 1 day preoperatively, 1 day postoperatively, 7 days postoperatively, and >6 months postoperatively (long-term) were 10.81, 116.74, 118.44, and 56.20 mL/min respectively. Intraoperative graft patency was confirmed in all patients. Comparing the preoperative and all postoperative time points, the STA-PB flow rates were statistically significant (p < 0.001). The MCA-C score was significantly associated with postoperative flow rate on day 1 (p = 0.007). CONCLUSION The STA is a useful donor artery for direct revascularization inpatients with MMD and can provide sufficient blood supply to the ischemic cerebral territory.
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Affiliation(s)
- Yunyu Wen
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Yanxia Gou
- Department of Stomatology, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Baoping Wang
- Department of Ultrasound, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Zhibin Wang
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Siyuan Chen
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Shichao Zhang
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Guozhong Zhang
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Mingzhou Li
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Wenfeng Feng
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
| | - Gang Wang
- Department of Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
- Laboratory for Precision Neurosurgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
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5
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Wang X, Tong X, Liu J, Shi M, Shang Y, Wang H. Petrous Carotid to Upper Posterior Circulation Bypass for the Treatment of Basilar Trunk Aneurysm: A Novel High-Flow Intracranial-Intracranial Skull Base Bypass for Posterior Circulation. Oper Neurosurg (Hagerstown) 2023; 24:301-309. [PMID: 36729820 DOI: 10.1227/ons.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/11/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Basilar trunk aneurysms are the most surgically challenging, and the spectrum covers small fusiform to dolichoectatic aneurysms and may lead to rupture, brain ischemia, or direct brainstem compression. The current strategy remains cerebral revascularization coupled with aneurysm trapping. Available bypass options for upper posterior circulation (UPC) are based on (1) different flow volumes from diverse blood supplies and (2) distinct modulation purposes for cerebral revascularization; however, the potential compromise of eloquent perforators of the basilar trunk and the occurrence of fatal brainstem infarcts remain unacceptable. OBJECTIVE To innovate a high-flow intracranial-intracranial skull base bypass for posterior circulation to afford robust retrograde flow and shorten the graft length. METHODS We retrospectively reviewed our experience in the treatment of a patient with basilar trunk aneurysm and reported a novel bypass alternative supplied by petrous internal carotid artery to augment blood flow to the UPC by a pretemporal approach. RESULTS The postoperative course was uneventful, and there was no pons or midbrain ischemia or other complications. Postoperative computed tomography angiogram revealed the patency of bypass. There was no further development or rerupture observed during follow-up. CONCLUSION Petrous internal carotid artery as a donor site is a reliable bypass modality for UPC. This approach provides the utmost retrograde flow to alleviate the development of dissecting aneurysms, preserves eloquent perforators of the basilar trunk, maintains bypass patency, and shortens the graft course. Therefore, this novel therapeutic alternative could be beneficial for improving the prognosis of basilar trunk aneurysms.
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Affiliation(s)
- Xuan Wang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
- Laboratory of Microneurosurgery, Tianjin Neurosurgical Institute, Tianjin, China
- Tianjin Key Laboratory of Cerebral Vascular and Neural Degenerative Diseases, Tianjin, China
| | - Xiaoguang Tong
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
- Laboratory of Microneurosurgery, Tianjin Neurosurgical Institute, Tianjin, China
- Tianjin Key Laboratory of Cerebral Vascular and Neural Degenerative Diseases, Tianjin, China
| | - Jie Liu
- Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Minggang Shi
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
| | - Yanguo Shang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
| | - Hu Wang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
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6
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How I do it: internal maxillary artery to middle cerebral artery bypass to manage giant thrombosed internal carotid artery aneurysm. Acta Neurochir (Wien) 2023; 165:495-499. [PMID: 36547705 DOI: 10.1007/s00701-022-05463-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Internal maxillary artery (IMA) bypass has become popularized due to its medium-to-high blood flow, short graft length, and well-matched arterial caliber between donor and recipient vessels. METHOD We described an open surgery of a NEW "workhorse," the IMA bypass, to treat a giant, thrombosed cerebral aneurysm. The extracranial middle infratemporal fossa (EMITF) approach was used to unveil the pterygoid segment of the IMA for cerebral revascularization. CONCLUSION Although this technique is technically challenging, the variations in IMA can be effectively identified and sufficiently exposed in this technique to achieve favorable clinical outcomes with a high bypass patency rate.
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7
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Bozzetto M, Soliveri L, Volpi J, Remuzzi A, Barbieri A, Lanterna LAA, Lanzarone E. Computational fluid dynamic modeling of flow-altering surgical procedures: feasibility assessment on saccular aneurysm case study. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2022. [DOI: 10.1080/21681163.2022.2140310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Michela Bozzetto
- Laboratory of Medical Imaging, Istituto di Ricerche Famacologiche “Mario Negri” IRCCS, Ranica, Italy
| | - Luca Soliveri
- Laboratory of Medical Imaging, Istituto di Ricerche Famacologiche “Mario Negri” IRCCS, Ranica, Italy
| | - Jessica Volpi
- Department of Management, Information and Production and Engineering, University of Bergamo, Dalmine, Italy
| | - Andrea Remuzzi
- Department of Management, Information and Production and Engineering, University of Bergamo, Dalmine, Italy
| | - Antonio Barbieri
- Department of Neurosurgery, San Carlo Borromeo Hospital, Milan, Italy
| | | | - Ettore Lanzarone
- Department of Management, Information and Production and Engineering, University of Bergamo, Dalmine, Italy
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8
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Computed Tomography Perfusion Imaging Study of Intracranial Complex Aneurysms Treated by Internal Maxillary Artery Bypass Grafting. World Neurosurg 2022; 164:e1123-e1134. [PMID: 35654335 DOI: 10.1016/j.wneu.2022.05.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cerebral revascularization strategies through extracranial to intracranial bypass have been adopted in the management of complex intracranial aneurysms. The internal maxillary artery used as a donor in a bypass is an effective method. At present, there are few quantitative analyses of cerebral blood flow perfusion. The main focus of this study was to evaluate the effectiveness of blood perfusion after bypass grafting. METHODS From April 2015 to December 2017, 19 patients who underwent internal maxillary artery radial artery middle cerebral artery bypass surgery with unobstructed bypass vessels were selected. Cerebral blood flow perfusion before and after bypass surgery was quantitatively evaluated by computed tomography perfusion imaging. The cerebral blood perfusion in the region of interest was measured by computed tomography perfusion. RESULTS The aneurysms were excised after trapping in 2 cases with mass effects and neural compression. Proximal occlusion of the parent artery was performed in 9 cases of fusiform or giant dissecting aneurysms. Trapping was performed after bypass surgery in 8 cases. Within 3 months after surgery, 17 patients had good outcomes. After the hypothesis test, there was a significant difference between the preoperative △cerebral blood volume and postoperative △cerebral blood volume in the anterior area of the semioval center cross section (P = 0.001 < 0.05). CONCLUSIONS The internal maxillary artery as a bypass donor is an effective method that can provide sufficient intracranial blood perfusion, and there is usually no cerebral ischemia in the surrounding area.
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Sergeev AV, Savello AV, Cherebillo VU, Kiskaev AI, Chemurzieva F. Sequential approach of internal maxillary-to-middle cerebral artery bypass and endovascular occlusion for giant middle cerebral artery aneurysm: a case report. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00288-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The combined approach to complex brain МСА aneurysm seems to be generally considered viable. Although it is fairly common, the combinations of modalities, which are suggested in different case reports, vary significantly. This case discusses a sequential approach of reconstructive microsurgery with internal maxillary-to-middle cerebral artery bypass followed by the balloon test occlusion and endovascular embolization of the aneurysm and the MCA. The combined approach together with use of maxillary artery helped minimize the intraoperative and postoperative complications.
Case presentation
A 62-year-old female with rare episodes of headache and depression revealed giant middle cerebral artery aneurysm. The patient underwent a combined operation in a hybrid operating room with no serious neurologic deficit after surgery.
Conclusions
Multimodality management in a hybrid operating room should be considered in case of complex fusiform aneurysm of MCA, which is associated with high risks of clipping. Thus, the sequential procedures will improve patient outcomes in treatment of complex МСА aneurysms.
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Shah A, Vutha R, Doshi J, Trivedi N, Goel A. "Flow Reversal" and Cure in a Case of Giant Intracranial Aneurysm: A Case Report. J Neurol Surg A Cent Eur Neurosurg 2021; 83:602-605. [PMID: 34077980 DOI: 10.1055/s-0041-1726106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We describe the case of an 11-year-old girl having a giant anterior circulation aneurysm. The ipsilateral internal carotid artery was entirely blocked and the aneurysm was supplied by posterior circulation. Following a high-flow bypass that connected the external carotid artery to the middle cerebral artery, the giant aneurysm thrombosed spontaneously. We discuss several relatively rare and unique features of the case.
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Affiliation(s)
- Abhidha Shah
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India
| | - Ravikiran Vutha
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India
| | - Jash Doshi
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India
| | - Nishit Trivedi
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India
| | - Atul Goel
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India.,Department of Neurosurgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
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11
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Wang L, Jing L, Sun H, Shi X. Letter to the Editor. Graft selection in cerebral revascularization surgery. J Neurosurg 2020; 134:1678-1679. [PMID: 32796148 DOI: 10.3171/2020.6.jns201957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Long Wang
- 1SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Lujun Jing
- 2Beijing Electric Power Hospital, Capital Medical University, Beijing, China
| | - Huaiyu Sun
- 3TieMei General Hospital of Liaoning Health Industry Group, Liaoning, China; and
| | - Xiang'en Shi
- 4SanBo Brain Hospital, Capital Medical University, Beijing, China
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12
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AlTinawi B, Vasilakis G, Marsh R. Surgical treatment of a giant intracranial serpentine complex aneurysm of the middle cerebral artery: Use of neuromonitoring and surgical decision tree analysis. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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13
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Matano F, Murai Y, Sato S, Koketsu K, Shirokane K, Ishisaka E, Tsukiyama A, Morita A. Risk factors for ischemic complications in vascular reconstructive surgeries. Clin Neurol Neurosurg 2020; 193:105768. [DOI: 10.1016/j.clineuro.2020.105768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
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14
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Wang L, Lu S, Cai L, Qian H, Tanikawa R, Shi X. Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms. Neurosurg Focus 2020; 46:E10. [PMID: 30717068 DOI: 10.3171/2018.11.focus18457] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/14/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVEThe rapid innovation of the endovascular armamentarium results in a decreased number of indications for a classic surgical approach. However, a middle cerebral artery (MCA) aneurysm remains the best example of one for which results have favored microsurgery over endovascular intervention. In this study, the authors aimed to evaluate the experience and efficacy regarding surgical outcomes after applying internal maxillary artery (IMA) bypass for complex MCA aneurysms (CMCAAs).METHODSAll IMA bypasses performed between January 2010 and July 2018 in a single-center, single-surgeon practice were screened.RESULTSIn total, 12 patients (9 males, 3 females) with CMCAAs managed by high-flow IMA bypass were identified. The mean size of CMCAAs was 23.7 mm (range 10-37 mm), and the patients had a mean age of 31.7 years (range 14-56 years). The aneurysms were proximally occluded in 8 cases, completely trapped in 3 cases, and completely resected in 1 case. The radial artery was used as the graft vessel in all cases. At discharge, the graft patency rate was 83.3% (n = 10), and all aneurysms were completely eliminated (83.3%, n = 10) or greatly diminished (16.7%, n = 2) from the circulation. Postoperative ischemia was detected in 2 patients as a result of graft occlusion, and 1 patient presenting with subarachnoid hemorrhage achieved improved modified Rankin Scale scores compared to the preoperative status but retained some neurological deficits. Therefore, neurological assessment at discharge showed that 9 of the 12 patients experienced unremarkable outcomes. The mean interval time from bypass to angiographic and clinical follow-up was 28.7 months (range 2-74 months) and 53.1 months (range 19-82 months), respectively. Although 2 grafts remained occluded, all aneurysms were isolated from the circulation, and no patient had an unfavorable outcome.CONCLUSIONSThe satisfactory result in the present study demonstrated that IMA bypass is a promising method for the treatment of CMCAAs and should be maintained in the neurosurgical armamentarium. However, cases with intraoperative radical resection or inappropriate bypass recipient selection such as aneurysmal wall should be meticulously chosen with respect to the subtype of MCA aneurysm.
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Affiliation(s)
- Long Wang
- 1Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China.,2Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Shuaibin Lu
- 3Department of Neurosurgery, Beijing Shijingshan Hospital, Beijing, China
| | - Li Cai
- 4Department of Neurosurgery, The First Affiliated Hospital of University of South China, Hengyang, China.,5Arkansas Neuroscience Institute, St. Vincent Hospital, Little Rock, Arkansas; and
| | - Hai Qian
- 1Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Rokuya Tanikawa
- 2Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Xiang'en Shi
- 1Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China.,6Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing, China
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Kavak RP, Özdemir M, Kavak N, Yıldırım F. Basilar trunk artery aneurysm presenting with brainstem stroke. Radiol Case Rep 2020; 15:387-390. [PMID: 32071656 PMCID: PMC7013147 DOI: 10.1016/j.radcr.2020.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/31/2019] [Accepted: 01/07/2020] [Indexed: 11/17/2022] Open
Abstract
Basilar trunk artery aneurysms are extremely rare lesions that account for only 2.1% of all intracranial aneurysms. They are mostly recognized in patients around the age of 60, show a slight male predominance, and are associated with high morbidity and mortality. Chronic mural bleeding ectasia is the most common subtype of basilar trunk artery aneurysms. Its median maximum diameter ranges between 11 and 21 mm and is incidentally detected in more than half of the cases. Herein, we present a 58-year-old male patient who presented with brain stem stroke due to a chronic mural bleeding ectasia with a maximum diameter of 27 mm and died in the first week after admission.
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Affiliation(s)
- Rasime P. Kavak
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Radiology, Radyoloji Kliniği. Ziraat mah. Şehit Ömer Halisdemir cad. No:20 Altındağ, Ankara, Turkey
| | - Meltem Özdemir
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Radiology, Radyoloji Kliniği. Ziraat mah. Şehit Ömer Halisdemir cad. No:20 Altındağ, Ankara, Turkey
| | - Nezih Kavak
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Emergency Medicine. Acil Tıp Kliniği. Ziraat mah. Şehit Ömer Halisdemir cad. No:20 Altındağ, Ankara, Turkey
| | - Ferhat Yıldırım
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Radiology, Radyoloji Kliniği. Ziraat mah. Şehit Ömer Halisdemir cad. No:20 Altındağ, Ankara, Turkey
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Blind-Alley Formation and Occipital Artery-Posterior Inferior Cerebellar Artery Bypass for the Treatment of Unclippable Vertebral Artery Aneurysms with Posterior Inferior Cerebellar Artery Involvement. World Neurosurg 2020; 138:e539-e550. [PMID: 32156594 DOI: 10.1016/j.wneu.2020.02.174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND IMPORTANCE Unclippable vertebral artery aneurysms (UVAs) are difficult to treat with direct clipping, especially in cases involving the origin of the posterior inferior cerebellar artery (PICA). Bypass with trapping is the common procedure used for these conditions. The authors used the blind-alley formation technique, which is a simpler method than trapping and can avoid some complications. OBJECTIVES To report 7 cases of UVA with PICA involvement treated with blind-alley formation and occipital artery (OA)-PICA bypass as well as their surgical outcomes and complications and to describe the operative techniques. RESULTS Seven patients with UVA and PICA involvement underwent OA-PICA bypass and blind-alley formation (occlusions of the PICA origin and vertebral artery proximal to the aneurysm). Vertebral artery dissecting aneurysms and fusiform atherosclerotic vertebral artery aneurysms were detected in 6 patients and 1 patient, respectively. All patients presented with subarachnoid hemorrhage, and 71.4% of them were classified into the poor-grade group. Good bypass patency and complete aneurysm obliteration were achieved in all cases. Six aneurysms (85.7%) were completely obliterated according to computed tomography angiography performed immediately postoperatively. Another aneurysm was 50% and 100% thrombosed immediately and at 7 days after the operation, respectively. Surgical complications were found in 1 patient (14.3%) who had postoperative diparesis with dysphagia. Three patients (42.9%) achieved a Glasgow Outcome Score of 4 or 5 one month after the operation. CONCLUSIONS Blind-alley formation and OA-PICA bypass are simple, safe, and effective for the treatment of patients with UVA with PICA involvement.
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Wang L, Shi X, Qian H. Letter to the Editor Regarding "Giant Serpentine Distal Anterior Cerebral Artery Aneurysm Treated with In Situ Side-to-Side A3-A3 Anastomosis and Aneurysm Resection". World Neurosurg 2020; 135:393. [PMID: 32143251 DOI: 10.1016/j.wneu.2019.11.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Long Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China.
| | - Xiang'en Shi
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Hai Qian
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
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Zhang J, Shi X, Liu F, Sun Y, Qian H, Zhou Z, Zhang Y, Wang L. Natural history and clinical outcomes in patients with complex intracranial aneurysms: a review of 115 bypass cases and 22 nonsurgical cases. Neurosurg Rev 2019; 43:1605-1613. [PMID: 31707577 DOI: 10.1007/s10143-019-01191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/13/2019] [Accepted: 10/01/2019] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the natural history of patients with these heterogeneous aneurysms to provide guidance for their treatment. This retrospective analysis was performed at a single institution and included 137 patients with complex intracranial aneurysms who underwent a natural history evaluation. Among the 115 patients who underwent bypass surgery, stroke (n = 39, 33.9%) was the most common clinical symptom followed by progressively severe headaches (n = 25, 21.7%). Of the 104 patients with follow-up information, 87 (83.7%) returned to a normal life within a mean follow-up of 4.17 ± 2.09 years. Ten deaths (9.6%) occurred after a mean of 1.3 ± 0.9 years. Among the 22 patients who selected nonsurgical treatment, mass effect (n = 9, 40.9%) was the most common clinical presentation, and 14 deaths (63.6%) occurred after a mean of 3.3 ± 2.5 years. The modified Rankin scale (mRS) scores of 5 survivors (5/22, 22.7%) progressed from 0-2 at initial presentation to 3-4. Bypass surgical treatment for these aneurysms appears to be effective and can achieve good clinical outcomes without additional limitations related to individual aneurysms despite the impact of recent endovascular techniques on vascular surgery.
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Affiliation(s)
- Jie Zhang
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, No. 20, FuxingMenwai Rd., Xicheng District, Beijing, 100038, People's Republic of China
| | - Xiang'en Shi
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, No. 20, FuxingMenwai Rd., Xicheng District, Beijing, 100038, People's Republic of China.
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, No. 50 Yikesong Rd, Haidian District, Beijing, 100093, China.
| | - Fangjun Liu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, No. 50 Yikesong Rd, Haidian District, Beijing, 100093, China
| | - Yuming Sun
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, No. 50 Yikesong Rd, Haidian District, Beijing, 100093, China
| | - Hai Qian
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, No. 50 Yikesong Rd, Haidian District, Beijing, 100093, China
| | - Zhongqing Zhou
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, No. 50 Yikesong Rd, Haidian District, Beijing, 100093, China
| | - Yongli Zhang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, No. 50 Yikesong Rd, Haidian District, Beijing, 100093, China
| | - Long Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, No. 50 Yikesong Rd, Haidian District, Beijing, 100093, China
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Zaki Ghali MG, Srinivasan VM, Britz GW. Maxillary Artery to Intracranial Bypass. World Neurosurg 2019; 128:532-540. [DOI: 10.1016/j.wneu.2019.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 12/16/2022]
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Intracranial–Intracranial Bypass with a Graft Vessel: A Comprehensive Review of Technical Characteristics and Surgical Experience. World Neurosurg 2019; 125:285-298. [DOI: 10.1016/j.wneu.2019.01.259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 01/28/2019] [Indexed: 12/28/2022]
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21
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In Reply to “The Relevance of Surgical Anatomy for Harvesting the Internal Maxillary Artery and Nomenclature of a ‘New’ Bypass Technique”. World Neurosurg 2019. [DOI: 10.1016/j.wneu.2018.12.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Wang L, Qian H, Shi X. Direct Suturing Technique for Ruptured Blood-Blister Aneurysm: The Forgotten Way. World Neurosurg 2019; 123:471-472. [PMID: 30832183 DOI: 10.1016/j.wneu.2018.11.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Long Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China.
| | - Hai Qian
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiang'en Shi
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing, China
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Wang L, Shi X. Letter: Minimally Invasive Exposure of the Maxillary Artery at the Anteromedial Infratemporal Fossa. Oper Neurosurg (Hagerstown) 2019; 16:E110. [PMID: 30535408 DOI: 10.1093/ons/opy365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Long Wang
- Department of Neurosurgery SanBo Brain Hospital Capital Medical University Beijing, China
| | - Xiang'en Shi
- Department of Neurosurgery SanBo Brain Hospital Capital Medical University Beijing, China
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Wang L, Qian H, Shi X. Underestimation of Extracranial-to-Intracranial Bypass in Management of Vertebrobasilar Dolichoectatic Aneurysm. World Neurosurg 2018; 119:462. [PMID: 30347580 DOI: 10.1016/j.wneu.2018.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Long Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Hai Qian
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiang'en Shi
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China.
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Wang L, Cai L, Qian H, Shi X. Overestimated Role of Extracranial-to-Intracranial Bypass in Management of Blood-Blister Aneurysm. World Neurosurg 2018; 118:391-392. [PMID: 30248817 DOI: 10.1016/j.wneu.2018.06.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 06/19/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Long Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Li Cai
- Department of Neurosurgery, The First Affiliated Hospital of University of South China, Hengyang, China; Arkansas Neuroscience Institute, CHI St. Vincent Infirmary, Little Rock, Arkansas, USA
| | - Hai Qian
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiang'en Shi
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China.
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Wang L, Cai L, Qian H, Tanikawa R, Lawton M, Shi X. The re-anastomosis end-to-end bypass technique: a comprehensive review of the technical characteristics and surgical experience. Neurosurg Rev 2018; 42:619-629. [PMID: 30255374 DOI: 10.1007/s10143-018-1036-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/04/2018] [Accepted: 09/18/2018] [Indexed: 11/24/2022]
Abstract
Re-anastomosis end-to-end bypass is a straightforward subtype of intracranial-intracranial reconstruction technique that has been utilized to treat complex aneurysms and skull base tumors. This simple technique involves connecting the cut ends of an afferent and efferent artery under added tension after excising the lesion. The current study aims to provide a detailed description of the technical pitfalls, ideal anatomical sites and indications, and clinical outcomes for intracranial complex disorders. A literature search was performed using the terms "intracranial-intracranial bypass," "re-anastomosis bypass," "reconstructive bypass," "end-to-end bypass," and "end-to-end anastomosis" to identify pertinent articles. Articles involving end-to-end re-anastomosis combined with other bypass methods were excluded. Computer-tablet-drawn illustrations of this technique are provided to enhance comprehension. Eighty-six patients who met our search and inclusion criteria were identified between 1978 and the present. However, comprehensive descriptions of medical records and neuroimaging were available in only 41 cases (40 complex aneurysms and a skull base tumor). Of 40 reported cases of complex cerebral aneurysms treated by this technique, the overall rate of full recovery without complication is 87.5% (35/40). Meanwhile, all aneurysms were completely eliminated from the circulation, with 92.5% of bypasses being patent. End-to-end re-anastomosis remains a simple modality in the microsurgical bypass armamentarium. Safe and effective surgical outcomes can be achieved in select cases that rarely involve perforators or branches.
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Affiliation(s)
- Long Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, No. 50, Yikesong Rd, Haidian District, Beijing, 100093, China. .,Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan. .,Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - Li Cai
- Department of Neurosurgery, The First Affiliated Hospital of University of South China, Hengyang, China.,Arkansas Neuroscience Institute, St. Vincent Hospital, Little Rock, AR, USA
| | - Hai Qian
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, No. 50, Yikesong Rd, Haidian District, Beijing, 100093, China
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Michael Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Xiang'en Shi
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, No. 50, Yikesong Rd, Haidian District, Beijing, 100093, China.
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Wang L, Qian H, Shi X. Reiteration of "Less Invasive" Way and Graft Selections for Internal Maxillary Bypass. World Neurosurg 2018; 122:705-706. [PMID: 30205227 DOI: 10.1016/j.wneu.2018.08.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/31/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Long Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Bejing, China
| | - Hai Qian
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Bejing, China
| | - Xiang'en Shi
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Bejing, China.
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Wang L, Cai L, Qian H, Lawton MT, Shi X. The In Situ Side-To-Side Bypass Technique: A Comprehensive Review of the Technical Characteristics, Current Anastomosis Approaches, and Surgical Experience. World Neurosurg 2018; 115:357-372. [DOI: 10.1016/j.wneu.2018.04.173] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 12/18/2022]
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Wang L, Shi X, Qian H. Feasibility of Using Internal Thoracic Artery as Donor Vessel in High-Flow Intracranial Bypass Surgery. World Neurosurg 2018; 113:396. [PMID: 29702962 DOI: 10.1016/j.wneu.2018.01.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Long Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Xiang'en Shi
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Fu Xing Hospital, Capital Medical University, Beijing, China.
| | - Hai Qian
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
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Abstract
Internal maxillary artery (IMA) bypass has gained momentum in the last 5 years for the treatment of complex cerebrovascular disorders and skull base tumors. However, some issues regarding this treatment modality have been proposed. As one of the most experienced neurosurgical teams to perform internal maxillary artery bypass in the world (>100 clinical cases), we reviewed the literature in aspects of basic anatomy of maxillary artery with its variations to the lateral pterygoid muscle, initial anastomosis modalities, and subsequent exposure techniques in cadaver studies, preoperative arterial evaluation methods, optimal interposed graft selections, and surgical outcome in the management of complex aneurysms, skull base tumors, and steno-occlusive disorders.
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31
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Wang L, Shi X, Qian H. Letter: Graft Selection in High-Flow Internal Maxillary Artery Bypass. Oper Neurosurg (Hagerstown) 2018; 14:10-11. [PMID: 29088435 DOI: 10.1093/ons/opx222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Long Wang
- Department of Neurosurgery SanBo Brain Hospital Capital Medical University Beijing, China
| | - Xiang'en Shi
- Department of Neurosurgery Fu Xing Hospital Capital Medical University Beijing, China.,Department of Neurosurgery SanBo Brain Hospital Capital Medical University Beijing, China
| | - Hai Qian
- Department of Neurosurgery SanBo Brain Hospital Capital Medical University Beijing, China
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Feasibility of Using a Superficial Temporal Artery Graft in Internal Maxillary Artery Bypass. World Neurosurg 2017; 108:971-972. [DOI: 10.1016/j.wneu.2017.08.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 11/24/2022]
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Wang L, Lu S, Qian H, Shi X. Internal Maxillary Artery Bypass with Radial Artery Graft Treatment of Giant Intracranial Aneurysms. World Neurosurg 2017; 105:568-584. [DOI: 10.1016/j.wneu.2017.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 11/24/2022]
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Yağmurlu K, Spetzler RF. In Reply to “Is Internal Maxillary Artery Bypass Feasible without Zygomatic Osteotomy?”. World Neurosurg 2017; 104:1005. [DOI: 10.1016/j.wneu.2017.05.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
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Internal Maxillary Bypass for Complex Pediatric Aneurysms. World Neurosurg 2017; 103:395-403. [PMID: 28433837 DOI: 10.1016/j.wneu.2017.04.055] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Complex pediatric aneurysms (PAs) are an unusual clinicopathologic entity. Data regarding the use of a bypass procedure to treat complex PAs are limited. METHODS Internal maxillary artery-to-middle cerebral artery bypass with radial artery graft was used to isolate PAs. Bypass patency and aneurysm stability were evaluated using intraoperative Doppler ultrasound, indocyanine green videoangiography, and postoperative angiography. Modified Rankin Scale was used to assess neurologic function. RESULTS Over a 5-year period, 7 pediatric patients (≤18 years old) were included in our analysis. Mean age of patients was 14.4 years (range, 12-18 years), and mean size of PAs was 23.6 mm (range, 9-37 mm). All cases manifested with complex characteristics. Proximal artery occlusion was performed in 3 cases, complete excision following aneurysmal distal internal maxillary artery bypass was performed in 2 cases, and combined proximal artery occlusion and aneurysm excision was performed in the 2 remaining cases. Mean intraoperative blood flow was 61.6 mL/minute (range, 40.0-90.8 mL/minute). Graft patency rate was 100% during postoperative recovery and at the last follow-up examination (mean, 20 months; range, 7-45 months). All patients had excellent outcomes except for 1 patient who died of multiple-organ failure. CONCLUSIONS Internal maxillary artery bypass is an essential technique for treatment of selected cases of complex PAs.
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