Abstract
The Extra-Intracranial (EC-IC) arterial Bypass = EIAB has been proposed by Yasargil and Donaghy in 1967 to bypass an occlusive process in the arteries supplying the brain that is not accessible surgically in another way. Following a rise in the number of procedures performed annually worldwide, a sharp decline followed after the International EC-IC Bypass Study had shown that the addition of EIAB did not improve the long-term results in the study population compared to best medical therapy by aspirin alone.
On the basis of a better understanding of the origin of cerebral ischemic events, more precise indications have been developed targeting to improve hemodynamic insufficiency, by surgically adding an extra-cranial arterial supply. Furthermore, technical improvements of the procedure allow more deliberate indication for EIAB, e.g. using high-flow bypass while performing an “occlusion-free” anastomosis. Also, variations of the technique of encephalo-myo-synangiosis for Moya-Moya disease patients allow additional blood supply to the brain hemispheres.
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References
Amin-Hanjani S, Chen PR, Chang SW, Spetzler RF (2006) Long-term follow-up of giant serpentine MCA aneurysm treated with EC-IC bypass and proximal occlusion. Acta Neurochir (Wien) 148: 227–228
Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke (1985) Results of an international randomized trial. The EC/IC Bypass Study Group. N Engl J Med 313: 1191–1200
Hacein-Bey L, Connolly ES, Duong H, Vang MC, Lazar RM, Marshall RS, Young WL, Solomon RA, Pile-Spellman J (1997) Treatment of inoperable carotid aneurysms with endovascular carotid occlusion after extracranial-intracranial bypass surgery. Neurosurgery 41: 1225–1234
Hendrikse J, van der Zwan A, Ramos LM, Tulleken CA, van der Grond J (2003) Hemodynamic compensation via an excimer laser-assisted, high-flow bypass before and after therapeutic occlusion of the internal carotid artery. Neurosurgery 53: 858–865
Holzschuh M, Brawanski A, Ullrich W, Meixensberger J (1991) Cerebral blood flow and cerebrovascular reserve 5 years after EC-IC bypass. Neurosurg Rev 14: 275–278
Jinnouchi J, Toyoda K, Inoue T, Fujimoto S, Gotoh S, Yasumori K, Ibayashi S, Iida M, Okada Y (2006) Changes in brain volume 2 years after extracranial-intracranial bypass surgery: a preliminary subanalysis of the Japanese EC-IC trial. Cerebrovasc Dis 22: 177–182
Karnchanapandh K, Imizu M, Kato Y, Sano H, Hayakawa M, Kanno T (2002) Successful obliteration of a ruptured partially thrombosed giant m1 fusiform aneurysm with coil embolization at distal m1 after extracranial-intracranial bypass. Minim Invas Neurosur 45: 245–250
Khan N, Schinzel A, Shuknecht B, Baumann F, Ostergaard JR, Yonekawa Y (2004) Moyamoya angiopathy with dolichoectatic internal carotid arteries, patent ductus arteriosus and pupillary dysfunction: a new genetic syndrome? Eur Neurol 51: 72–77
Kleiser B, Widder B (1992) Course of carotid artery occlusions with impaired cerebrovascular reactivity. Stroke 23: 171–174
Klijn CJ, Kappelle LJ, van der Zwan A, van Gijn J, Tulleken CA (2002) Excimer laser-assisted high-flow extracranial/intracranial bypass in patients with symptomatic carotid artery occlusion at high risk of recurrent cerebral ischemia: safety and long-term outcome. Stroke 33: 2451–2458
Kobayashi H, Hayashi M, Handa Y, Kabuto M, Noguchi Y, Aradachi H (1991) EC-IC bypass for adult patients with moyamoya disease. Neurol Res 13: 113–116
Kuwabara Y, Ichiya Y, Sasaki M, Yoshida T, Masuda K, Ikezaki K, Matsushima T, Fukui M (1997) Cerebral hemodynamics and metabolism in moyamoya disease — a positron emission tomography study. Clin Neurol Neurosurg (Suppl 2) 99: 74–78
Mehdorn HM, Vyska K, Machulla HJ, Knust EJ (1985) Use of 3-fluoro-deoxyglucose for the assessment of cerebral perfusion and glucose transport. II. Evaluation of patients undergoing EC-IC bypass surgery. Neurol Res 7: 68–74
Mehdorn HM, Nau HE, Forster M (1986) Carotid artery occlusion and ocular ischemia: Therapy control with evoked potentials. Neurosurgery 19: 1031–1034
Mehdorn HM, Hoffmann B, Feldges A (1991) Indications for invasive diagnostic studies and surgical therapy in cerebral ischemia, based on results of non-invasive transcranial Doppler sonography. Neurosurg Rev 14: 261–265
Peerless SJ (1986) Indications for the extracranial-intracranial arterial bypass in light of the EC-IC bypass study. Clin Neurosurg 33: 307–326
Piepgras A, Schmiedek P, Leinsinger G, Haberl RL, Kirsch CM, Einhaupl KM (1990) A simple test to assess cerebrovascular reserve capacity using transcranial Doppler sonography and acetazolamide. Stroke 21: 1306–1311
Sasoh M, Ogasawara K, Kuroda K, Okuguchi T, Terasaki K, Yamadate K, Ogawa A (2003) Effects of EC-IC bypass surgery on cognitive impairment in patients with hemodynamic cerebral ischemia. Surg Neurol 59: 455–463
Schmiedek P, Piepgras A, Leinsinger G, Kirsch CM, Einhäupl K (1994) Improvement of cerebrovascular reserve capacity by EC-IC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia. J Neurosurg 81: 236–244
Sekhar LN, Sen CN, Jho HD (1990) Saphenous vein graft bypass of the cavernous internal carotid artery. J Neurosurg 72: 35–41
Serbinenko FA, Filatov JM, Spallone A, Tchurilov MV, Lazarev VA (1990) Management of giant intracranial ICA aneurysms with combined extracranial-intracranial anastomosis and endovascular occlusion. J Neurosurg 73: 57–63
Spetzler RF, Selman W, Carter LP (1984) Elective EC-IC bypass for unclippable intracranial aneurysms. Neurol Res 6: 64–68
Streefkerk HJ, Van der Zwan A, Verdaasdonk RM, Beck HJ, Tulleken CA (2003) Cerebral revascularization. Review. Adv Tech Stand Neurosurg 28: 145–225
Widder B (1989) The Doppler CO2 test to exclude patients not in need of extracranial/intracranial bypass surgery. J Neurol Neurosurg Psychiatry 52: 38–42
Yeh H, Tomsick TA (1997) Obliteration of a giant carotid aneurysm after extracranial-to-intracranial bypass surgery. Case report. Surg Neurol 48: 473–476
Yasargil MG (ed) (1969) Microsurgery applied to neurosurgery. Thieme, Stuttgart, New York
Yonas H, Smith HA, Durham SR, Pentheny SL, Johnson DW (1993) Increased stroke risk predicted by compromised cerebral blood flow reactivity. J Neurosurg 79: 483–489
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Mehdorn, H.M. (2008). Cerebral revascularization by EC-IC bypass — present status. In: Yonekawa, Y., Tsukahara, T., Valavanis, A., Khan, N. (eds) Changing Aspects in Stroke Surgery: Aneurysms, Dissections, Moyamoya Angiopathy and EC-IC Bypass. Acta Neurochirurgica Supplements, vol 103. Springer, Vienna. https://doi.org/10.1007/978-3-211-76589-0_13
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DOI: https://doi.org/10.1007/978-3-211-76589-0_13
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