Extracranial⁃intracranial bypass for giant intracranial aneurysms

Abstract

Objective To report bypass treatment for 6 cases of giant intracranial aneurysm, and discuss the surgical indication and therapeutic effect. Methods A series of 6 patients with giant intracranial aneurysm underwent extracranial ⁃ intracranial bypass. Pre ⁃ operative cerebral hemodynamics, mode of bypass, and the clinical and imaging outcomes were analysed. Results Among 6 patients, 3 patients underwent trapping and resection (or parent vessel reconstruction) combined with low⁃flow bypass while the other 3 patients underwent clipping (or trapping) combined with high⁃flow bypass (external carotid artery⁃radial artery/great saphenous vein⁃middle cerebral artery bypass). The follow⁃up period ranged from 6 to 28 months (mean 17 months). The short⁃term and long⁃term cerebral aniography and CT angiography showed the bypass vessel and anastomotic stoma were all patent. Signs and symptoms were improved in different degree. During follow ⁃ up period, no acute hemorrhagic or ischemic cerebrovascular events occurred. Among 3 patients who underwent combined low ⁃ flow bypass, the long ⁃ term modified Rankin Scale (mRS) was 0 in 2 patients and 2 in one patient. Among the other 3 patients who underwent combined high⁃flow bypass, the long⁃term mRS was 0 in one and 1 in 2 patients. Conclusion Surgical treatment for complex intracranial aneurysm may sacrifice the parent vessel or the distal MCA branches. It is according to the patients condition and different intracranial ⁃ extracranial vascular bypass which may effectively preserve the blood flow. Perfusion CT in combination with digital subtraction angiography can be used to evaluate distal perfusion status and collateral circulation in patients with giant intracranial aneurysm. DOI：10.3969/j.issn.1672⁃6731.2012.01.009

Keywords

• Intracranial aneurysm
• Subarachnoid hemorrhage
• Cerebral revascularization