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High flow extracranial to intracranial vascular bypass procedure for giant aneurysms: indications, surgical technique, complications and outcome

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Advances and Technical Standards in Neurosurgery

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 34))

Abstract

High flow extracranial-intracranial (hfEC-IC) vascular bypass remains an important surgical technique in selected patients. For example, in those with giant aneurysms where the natural history of the condition is poor, and direct surgical approaches are recognised as excessively hazardous. hfEC-IC also allows for major carotid vessel occlusion in the treatment of skull base tumours which would otherwise be untreatable. We describe the indications, techniques, complications, and outcomes of this procedure in an era where few neurosurgeons are exposed to high volume vascular neurosurgery, and fewer still are trained to perform hfEC-IC. We emphasise the need for a stereo-typed and meticulous technique, highlighting key points at each stage of the operation, to ensure graft survival and minimal chances of morbidity.

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References

  1. Anson JA (1995) Epidemiology and natural history. In: Awad I, Barrow D (eds) Giant intracranial aneurysms. Thieme, Stuttgart

    Google Scholar 

  2. Barker DW, Jungreis CA, Horton JA, Pentheny S, Lemley T (1993) Balloon test occlusion of the internal carotid artery: change in stump pressure over 15 minutes and its correlation with xenon CT cerebral blood flow. Am J Neuroradiol 14: 587–90

    CAS  PubMed  Google Scholar 

  3. Barrow DL, Alleyne C (1995) Natural history of giant intracranial aneurysms and indications for intervention. Clin Neurosurg 42: 214–44

    CAS  PubMed  Google Scholar 

  4. Carlson A, Yonas H (2006) Monitoring carotid interventions with Xenon CT. In: Gillard J, Graves M, Hatsukami T, Yuan C (eds) Carotid disease: role of imaging in diagnosis and management, Cambridge University Press, Cambridge

    Google Scholar 

  5. Choi IS, David C (2003) Giant intracranial aneurysms: development, clinical presentation and treatment. Eur J Radiol 46: 178–94

    Article  PubMed  Google Scholar 

  6. Conley JJ (1953) Free autogenous vevin graft to the internal and common carotid arteries in the treatment of tumours in the neck. Ann Surg 137: 205–14

    Article  CAS  PubMed  Google Scholar 

  7. Drake CG (1979) Giant intracranial aneurysms: experience with surgical treatment in 174 patients. Clin Neurosurg 26: 12–95

    CAS  PubMed  Google Scholar 

  8. Drake CG, Peerless SJ, Ferguson GG (1994) Hunterian proximal arterial occlusion for giant aneurysms of the carotid circulation. J Neurosurg 81: 656–65

    Article  CAS  PubMed  Google Scholar 

  9. Fox AJ, Vinuela F, Pelz DM, Peerless SJ, Ferguson GG, Drake CG, et al. (1987) Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66: 40–46

    Article  CAS  PubMed  Google Scholar 

  10. Hacein-Bey L, Connolly ES Jr, Mayer SA, Young WL, Pile-Spellman J, Solomon RA (1998) Complex intracranial aneurysms: combined operative and endovascular approaches. Neurosurgery 43: 1304–12; discussion 1312–13

    Article  CAS  PubMed  Google Scholar 

  11. Herkes GK, Morgan M, Grinnell V, Sorby W, Wong J, Rowe D, et al. (1993) EEG monitoring during angiographic balloon test carotid occlusion: experience in sixteen cases. Clin Exp Neurol 30: 98–103

    CAS  PubMed  Google Scholar 

  12. Heros RC, Ameri AM (1984) Rupture of a giant basilar aneurysm after saphenous vein interposition graft to the posterior cerebral artery. Case report. J Neurosurg 61: 387–90

    Article  CAS  PubMed  Google Scholar 

  13. Houkin K, Kamiyama H, Kuroda S, Ishikawa T, Takahashi A, Abe H (1999) Long-term patency of radial artery graft bypass for reconstruction of the internal carotid artery. Technical note. J Neurosurg 90: 786–90

    CAS  Google Scholar 

  14. Jafar JJ, Russell SM, Woo HH (2002) Treatment of giant intracranial aneurysms with saphenous vein extracranial-to-intracranial bypass grafting: indications, operative technique, and results in 29 patients. Neurosurgery 51: 138–44; discussion 144–46.

    Article  PubMed  Google Scholar 

  15. Kocaeli H, Andaluz N, Choutka O, Zuccarello M (2008) Use of radial artery grafts in extracranial-intracranial revascularization procedures. Neurosurg Focus 24: E5

    Article  PubMed  Google Scholar 

  16. Larson JJ, Tew JM Jr, Tomsick TA, van Loveren HR (1995) Treatment of aneurysms of the internal carotid artery by intravascular balloon occlusion: long-term follow-up of 58 patients. Neurosurgery 36: 26–30; discussion 30

    Article  CAS  PubMed  Google Scholar 

  17. Lawton MT, Hamilton MG, Morcos JJ, Spetzler RF (1996) Revascularization and aneurysm surgery: current techniques, indications, and outcome. Neurosurgery 38: 83–92; discussion 92–4

    Article  CAS  PubMed  Google Scholar 

  18. Lougheed WM, Marshall BM, Hunter M, Michel ER, Sandwith-Smyth H (1971) Common carotid to intracranial internal carotid bypass venous graft. Technical note. J Neurosurg 34: 114–18

    Article  CAS  PubMed  Google Scholar 

  19. Marshall RS, Lazar RM, Young WL, Solomon RA, Joshi S, Duong DH, et al. (2002) Clinical utility of quantitative cerebral blood flow measurements during internal carotid artery test occlusions. Neurosurgery 50: 996–1004; discussion 1004–05

    Article  PubMed  Google Scholar 

  20. Mathis JM, Barr JD, Jungreis CA, Yonas H, Sekhar LN, Vincent D, et al. (1995) Temporary balloon test occlusion of the internal carotid artery: experience in 500 cases. Am J Neuroradiol 16: 749–54

    CAS  PubMed  Google Scholar 

  21. Mohit AA, Sekhar LN, Natarajan SK, Britz GW, Ghodke B (2007) High-flow bypass grafts in the management of complex intracranial aneurysms. Neurosurgery 60: ONS 105–22; discussion ONS 122–23

    Article  Google Scholar 

  22. Morgan MK, Ferch RD, Little NS, Harrington TJ (2002) Bypass to the intracranial internal carotid artery. J Clin Neurosci 9: 418–24

    Article  PubMed  Google Scholar 

  23. O’Shaughnessy BA, Salehi SA, Mindea SA, Batjer HH (2003) Selective cerebral revascularization as an adjunct in the treatment of giant anterior circulation aneurysms. Neurosurg Focus 14: e4

    Article  PubMed  Google Scholar 

  24. Plangger CA, Mohsenipour I, Grunert V, Twerdy K (1989) Rupture of a giant aneurysm of the inferior wall of the internal carotid artery after saphenous vein interposition graft to the middle cerebral artery. Zentralbl Neurochir 50: 61–63

    CAS  PubMed  Google Scholar 

  25. Polevaya NV, Kalani MY, Steinberg GK, Tse VC (2006) The transition from hunterian ligation to intracranial aneurysm clips: a historical perspective. Neurosurg Focus 20: E3

    Article  PubMed  Google Scholar 

  26. Regli L, Piepgras DG, Hansen KK (1995) Late patency of long saphenous vein bypass grafts to the anterior and posterior cerebral circulation. J Neurosurg 83: 806–11

    Article  CAS  PubMed  Google Scholar 

  27. Roski RA, Spetzler RF, Nulsen FE (1981) Late complications of carotid ligation in the treatment of intracranial aneurysms. J Neurosurg 54: 583–87

    Article  CAS  PubMed  Google Scholar 

  28. Sekhar LN, Kalavakonda C (2002) Cerebral revascularization for aneurysms and tumors. Neurosurgery 50: 321–31

    Article  PubMed  Google Scholar 

  29. Standard SC, Ahuja A, Guterman LR, Chavis TD, Gibbons KJ, Barth AP, et al. (1995) Balloon test occlusion of the internal carotid artery with hypotensive challenge. Am J Neuroradiol 16: 1453–58

    CAS  PubMed  Google Scholar 

  30. Sudhakar KV, Sawlani V, Phadke RV, Kumar S, Ahmed S, Gujral RB (2000) Temporary balloon occlusion of internal carotid artery: a simple and reliable clinical test. Neurol India 48: 140–43

    CAS  PubMed  Google Scholar 

  31. Sundt TM Jr, Piepgras DG, Marsh WR, Fode NC (1986) Saphenous vein bypass grafts for giant aneurysms and intracranial occlusive disease. J Neurosurg 65: 439–50

    Article  PubMed  Google Scholar 

  32. Swearingen B, Heros RC (1987) Common carotid occlusion for unclippable carotid aneurysms: an old but still effective operation. Neurosurgery 21: 288–95

    Article  CAS  PubMed  Google Scholar 

  33. Tulleken CA, Verdaasdonk RM, Berendsen W, Mali WP (1993) Use of the excimer laser in high-flow bypass surgery of the brain. J Neurosurg 78: 477–80

    Article  CAS  PubMed  Google Scholar 

  34. U-King-Im JM, Gillard J (2006) Conventional digital subtraction angiography for carotid disease. In: Gillard J, Graves M, Hatsukami T, Yuan C (eds) Carotid disease: role of imaging in diagnosis and management. Cambridge University Press, Cambridge

    Google Scholar 

  35. van Doormaal TP, van der Zwan A, Verweij BH, Langer DJ, Tulleken CA (2006) Treatment of giant and large internal carotid artery aneurysms with a high-flow replacement bypass using the excimer laser-assisted nonocclusive anastomosis technique. Neurosurgery 59: ONS 328–34; discussion ONS 334–35

    Google Scholar 

  36. van Rooij WJ, Sluzewski M, Slob MJ, Rinkel GJ (2005) Predictive value of angiographic testing for tolerance to therapeutic occlusion of the carotid artery. Am J Neuroradiol 26: 175–78

    PubMed  Google Scholar 

  37. Wolfe SQ, Tummala RP, Morcos JJ (2005) Cerebral revascularization in skull base tumors. Skull Base 15: 71–82

    Article  PubMed  Google Scholar 

  38. Yasargil MG (1967) Experimental small vessel surgery in the dog including patching and grafting of cerebral vessels in the form of functional extracranial-intracranial shunts. St Louis, Mosby

    Google Scholar 

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Authors and Affiliations

  1. Department of Academic Neurosurgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    H. C. Patel & P. J. Kirkpatrick

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  1. H. C. Patel
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  2. P. J. Kirkpatrick
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Patel, H.C., Kirkpatrick, P.J. (2009). High flow extracranial to intracranial vascular bypass procedure for giant aneurysms: indications, surgical technique, complications and outcome. In: Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 34. Springer, Vienna. https://doi.org/10.1007/978-3-211-78741-0_3

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  • DOI: https://doi.org/10.1007/978-3-211-78741-0_3

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-78740-3

  • Online ISBN: 978-3-211-78741-0

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