Therapeutic effectiveness of bypass and trapping treatment for complex intracranial aneurysms

Abstract

Objective To explore the selection and indication of intracranial⁃extracranial vascular anastomosis or bypass and trapping treatment for complex giant intracranial aneurysms. Methods The pre-operative assessment and surgical procedure of 12 patients with giant intracranial aneurysm admitted from Feb. 2008 to Dec. 2011 were analysed. Results There were 6 patients with internal carotid aneurysm (4 at cavernous sinus and clinoid process segment, and 2 at communicating branch), 3 with middle cerebral artery aneurysms, and 3 with posterior circulation aneurysms. Seven patients whose pre ⁃ operative MR perfusion imaging (MRP) showed obvious ischemia at the distal region of parent artery underwent superfical temporal artery⁃middle cerebral artery (STA⁃MCA) low flow vascular anastomosis. Five patients with rather long grafting vessel (≥ 15 cm) presented normal blood supply at the distal region of parent artery, pre ⁃ operative balloon occlusion test (BOT) negative, and insufficient filling of collateral circulation on cerebral angiography after compressed the neck of the affected side. These patients underwent intracranial ⁃ extracranial high flow vascular bypass. The outcome of 11 patients was good (modified Rankin Scale, 0-3), while the other was poor (modified Rankin Scale, 4). Conclusion Intracranial ⁃ extracranial vascular anastomosis or bypass and trapping treatment sometimes is the final option for complex intracranial aneurysms. Whether the blood supply at distal region of parent artery is normal or not will be the key to the selection for different flow vascular bypass (or anastomosis). Occipital artery, superfical temporal artery, and radial artery are commonly used as grafting vessels. DOI：10.3969/j.issn.1672⁃6731.2012.01.007

Keywords

• Intracranial aneurysm
• Subarachnoid hemorrhage
• Cerebral revascularization