Extracrainal ⁃ intracranial bypass for large and giant intracranial thrombotic aneurysms

Abstract

Objective To investigate the extracrainal⁃ intracranial (EC ⁃ IC) bypass for large and giant intracranial thrombotic aneurysms. Methods Fifteen patients of large or giant intracranial thrombotic aneurysms were treated with EC⁃IC bypass from March 2013 to July 2020 in The First Affiliated Hospital of Soochow University. Among them, there were 9 patients with large aneurysms (maximum diameter of aneurysm 1.50-2.50 cm) and 6 patients with giant aneurysms (maximum diameter of aneurysm＞2.50 cm). According to locations, there were 7 paraclinoid internal carotid artery (ICA) aneurysms, 3 supraclinoid ICA aneurysms, 3 middle cerebral artery (MCA) aneurysms and 2 ICA bifurcation aneurysms. Six cases were treated with low⁃flow superficial temporal artery (STA)⁃MCA bypass and aneurysmal clipping, 2 cases with STA⁃MCA bypass and aneurysmectomy, one with STA⁃MCA bypass and ligation of extracranial ICA, 4 patients with high⁃flow external carotid artery (ECA)⁃radial artery (RA)⁃MCA bypass and trapping of aneurysms, 2 patients with high ⁃flow ECA ⁃RA ⁃MCA bypass and aneurysmectomy. Results Aneurysm occlusion was confirmed in postoperative DSA or CTA in 15 patients and intraoperative TCD and indocyanine green angiography (ICGA) verified the patency of grafts. Thirteen patients achieved better outcome postoperatively. The muscle strength of contralateral limb in another one decrease following bypass. Emergency CT indicated ipsilateral basal ganglia infarction, and the muscle strength recovered to grade 5 after rehabilitation treatment. A mean 12.70 months follow ⁃ up was carried out. One patient suffered acute subdural hematoma 7 d following bypass and presented coma after a second craniotomy. Fourteen patients achieved good outcomes (GOS score 4-5) at last 6 months follow⁃up. One patient had a poor outcome (GOS score ≤ 3) at last 6 months follow⁃up. Conclusions EC⁃IC bypass can be individually carried out for large or giant intracranial thrombotic aneurysm. Preoperative assessment of cerebral hemodynamic and classification of aneurysms can provide favorable support for treatment.

Keywords

• intracranial aneurysm
• intracranial thrombosis
• carotid artery internal
• middle cerebral artery
• cerebral revascularization
• cerebral angiography