Intracranial-Intracranial Bypass for Aneurysms: Quantitative Intraoperative Assessment of Flow Preservation.
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
01 05 2022
01 05 2022
Historique:
received:
27
10
2021
accepted:
27
11
2021
pubmed:
23
3
2022
medline:
20
4
2022
entrez:
22
3
2022
Statut:
ppublish
Résumé
Intraoperative flow measurement has proven utility in extracranial-intracranial bypass, particularly in assessing the adequacy of donors by measurement of cut flow. The nature of intracranial-intracranial (IC-IC) bypass precludes cut flow measurement, but quantitative intraoperative flow measurements may evaluate augment assessment of the bypass. To retrospectively evaluate flow measurements performed in IC-IC bypass to determine the adequacy of the constructs in preserving flow. With institutional review board approval, we performed a retrospective review of our bypass database from 2001 to 2021 for aneurysms treated with IC-IC bypass and with intraoperative flow measurements. Patients' preoperative characteristics, bypass indications, prebypass and postbypass intraoperative flow measurements, and patient outcomes were recorded. Of 346 bypasses, 21 cases using 22 IC-IC bypasses were included. The median age was 55 years; 13 of 21 cases were ruptured aneurysms. Aneurysms involved posterior inferior cerebellar artery (n = 7), middle cerebral artery (n = 6), distal anterior cerebral artery (n = 5), and anterior communicating artery (n = 3). Six bypasses were end-to-side (ETS), 10 were side-to-side (STS), and 6 were excisional with reanastomosis (end-to-end, ETE). Intraoperatively, 21 of the bypasses were patent; the postbypass/prebypass flow index averaged 1.15 (±0.32): ETE (n = 6) 1.22 ± 0.34 and ETS/STS bypasses (n = 15) 1.11 ± 0.32. All intraoperatively patent bypasses were patent on postoperative angiography. One occluded on delayed angiography without clinical sequelae. Despite advances in endovascular therapy, IC-IC bypass remains essential to the treatment of large and fusiform aneurysms. We demonstrate quantitatively that IC-IC donors provide adequate direct (ETE) and redistributed (STS ETS) flow to the recipient territory. Flow measurement provides valuable information regarding the patency and adequacy of IC-IC bypass for flow preservation.
Sections du résumé
BACKGROUND
Intraoperative flow measurement has proven utility in extracranial-intracranial bypass, particularly in assessing the adequacy of donors by measurement of cut flow. The nature of intracranial-intracranial (IC-IC) bypass precludes cut flow measurement, but quantitative intraoperative flow measurements may evaluate augment assessment of the bypass.
OBJECTIVE
To retrospectively evaluate flow measurements performed in IC-IC bypass to determine the adequacy of the constructs in preserving flow.
METHODS
With institutional review board approval, we performed a retrospective review of our bypass database from 2001 to 2021 for aneurysms treated with IC-IC bypass and with intraoperative flow measurements. Patients' preoperative characteristics, bypass indications, prebypass and postbypass intraoperative flow measurements, and patient outcomes were recorded.
RESULTS
Of 346 bypasses, 21 cases using 22 IC-IC bypasses were included. The median age was 55 years; 13 of 21 cases were ruptured aneurysms. Aneurysms involved posterior inferior cerebellar artery (n = 7), middle cerebral artery (n = 6), distal anterior cerebral artery (n = 5), and anterior communicating artery (n = 3). Six bypasses were end-to-side (ETS), 10 were side-to-side (STS), and 6 were excisional with reanastomosis (end-to-end, ETE). Intraoperatively, 21 of the bypasses were patent; the postbypass/prebypass flow index averaged 1.15 (±0.32): ETE (n = 6) 1.22 ± 0.34 and ETS/STS bypasses (n = 15) 1.11 ± 0.32. All intraoperatively patent bypasses were patent on postoperative angiography. One occluded on delayed angiography without clinical sequelae.
CONCLUSION
Despite advances in endovascular therapy, IC-IC bypass remains essential to the treatment of large and fusiform aneurysms. We demonstrate quantitatively that IC-IC donors provide adequate direct (ETE) and redistributed (STS ETS) flow to the recipient territory. Flow measurement provides valuable information regarding the patency and adequacy of IC-IC bypass for flow preservation.
Identifiants
pubmed: 35315802
doi: 10.1227/ons.0000000000000136
pii: 01787389-202205000-00012
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
337-342Informations de copyright
Copyright © Congress of Neurological Surgeons 2022. All rights reserved.
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