The evaluation of intracranial bypass patency in neurosurgical practice.
Adult
Aged
Anastomosis, Surgical
/ methods
Cerebral Revascularization
/ methods
Female
Humans
Intracranial Aneurysm
/ diagnostic imaging
Magnetic Resonance Imaging
/ methods
Male
Microsurgery
/ methods
Middle Aged
Moyamoya Disease
/ diagnostic imaging
Neurosurgical Procedures
/ methods
Prospective Studies
Ultrasonography, Doppler, Transcranial
/ methods
Anastomose temporo-sylvienne
Aneurysm
Anévrisme
Bypass
Moya-Moya
MoyaMoya
Pontage
STA-MCA anastomosis
Journal
Neuro-Chirurgie
ISSN: 1773-0619
Titre abrégé: Neurochirurgie
Pays: France
ID NLM: 0401057
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
12
06
2020
revised:
04
09
2020
accepted:
01
10
2020
pubmed:
30
10
2020
medline:
6
7
2021
entrez:
29
10
2020
Statut:
ppublish
Résumé
The patency of cranial bypasses must be carefully evaluated during and after the microsurgical procedure. Although, several imaging techniques are used to evaluate the patency of bypasses, their findings are sometimes difficult to interpret. The goal of this study was to assess the consistency of different diagnostic modalities for evaluating intracranial bypass patency. This prospective study included 19 consecutive patients treated with EC-IC or IC-IC bypass for MoyaMoya disease (MMD) or complex/giant aneurysms between June 2016 and June 2018. In the early postoperative period (<7 days), all patients had transcranial Doppler (TCD), CT angiography (CTA) and MRA to demonstrate patency of anastomoses and to confirm exclusion of the aneurysm. When findings of anastomosis patency differed between these techniques, conventional angiography was performed. All anastomoses were patent on indocyanine green videoangiography at the end of microsurgical procedure. The results of noninvasive postoperative exams were consistent to demonstrate the patency of anastomoses in 13 patients. In 4 patients, a discrepancy in patency of anastomoses arose between TCD, CTA and MRI in the early postoperative period. In 2 other patients, the interpretation of bypass patency remained inconclusive before the decision to occlude the aneurysm. In these 6 patients, a significant edema was noted in 2 cases, a postoperative subdural hematoma in 1 case, a low flow in the anastomosis in 1 case and vasospasm in 2 cases. The anastomosis was patent on the conventional angiography in five patients. Noninvasive imaging techniques provide useful data about the patency but their findings should be carefully interpreted due to local anatomical, physiological, and pathological factors. In case of discrepant findings, conventional angiography including supraselective catheterization of the donor vessel is suggested.
Sections du résumé
BACKGROUND
BACKGROUND
The patency of cranial bypasses must be carefully evaluated during and after the microsurgical procedure. Although, several imaging techniques are used to evaluate the patency of bypasses, their findings are sometimes difficult to interpret.
PURPOSE
OBJECTIVE
The goal of this study was to assess the consistency of different diagnostic modalities for evaluating intracranial bypass patency.
PATIENTS AND METHOD
METHODS
This prospective study included 19 consecutive patients treated with EC-IC or IC-IC bypass for MoyaMoya disease (MMD) or complex/giant aneurysms between June 2016 and June 2018. In the early postoperative period (<7 days), all patients had transcranial Doppler (TCD), CT angiography (CTA) and MRA to demonstrate patency of anastomoses and to confirm exclusion of the aneurysm. When findings of anastomosis patency differed between these techniques, conventional angiography was performed.
RESULTS
RESULTS
All anastomoses were patent on indocyanine green videoangiography at the end of microsurgical procedure. The results of noninvasive postoperative exams were consistent to demonstrate the patency of anastomoses in 13 patients. In 4 patients, a discrepancy in patency of anastomoses arose between TCD, CTA and MRI in the early postoperative period. In 2 other patients, the interpretation of bypass patency remained inconclusive before the decision to occlude the aneurysm. In these 6 patients, a significant edema was noted in 2 cases, a postoperative subdural hematoma in 1 case, a low flow in the anastomosis in 1 case and vasospasm in 2 cases. The anastomosis was patent on the conventional angiography in five patients.
CONCLUSION
CONCLUSIONS
Noninvasive imaging techniques provide useful data about the patency but their findings should be carefully interpreted due to local anatomical, physiological, and pathological factors. In case of discrepant findings, conventional angiography including supraselective catheterization of the donor vessel is suggested.
Identifiants
pubmed: 33115607
pii: S0028-3770(20)30437-9
doi: 10.1016/j.neuchi.2020.10.001
pii:
doi:
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
125-131Informations de copyright
Copyright © 2020 Elsevier Masson SAS. All rights reserved.