The Efficacy of Bypass Surgery Using a Short Interposition Graft for the Treatment of Intracranial Complex Aneurysm

• Published in: World neurosurgery Vol. 83; no. 2; pp. 197 - 202
• Main Authors: Yang, Kuhyun, Ahn, Jae Sung, Park, Jung Cheol, Kwon, Do Hoon, Kwun, Byung Duk, Kim, Chang Jin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2015
• Subjects: Adult; Aneurysm, Ruptured - surgery; Bypass surgery; Cerebral Angiography; Cerebral Revascularization - methods; Cerebrovascular Circulation; Complex intracranial aneurysm; Female; Follow-Up Studies; Humans; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - pathology; Intracranial Aneurysm - surgery; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgery; Neurosurgical Procedures - methods; Radial Artery - transplantation; Retrospective Studies; Saphenous Vein - transplantation; Short interposition graft; Superficial temporal artery; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures - methods; STA; Short interposition graft; MRI; SVG; Middle cerebral artery; Anterior cerebral artery; Balloon test occlusion; Computed tomography; Complex intracranial aneurysm; ACA; Saphenous vein graft; ICA; Glasgow Outcome Scale; GOS; MCA; Superficial temporal artery; CT; Radial artery graft; Transfemoral cerebral angiography; Magnetic resonance imaging; Internal carotid artery; TFCA; RAG; Bypass surgery; BTO
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2014.06.008

Objective To evaluate the efficacy of a short interposition graft using saphenous vein or radial artery to connect the proximal superficial temporal artery and the M2 segments of the middle cerebral artery for the treatment of complex intracranial aneurysm. Methods From March 2007 to February 2012, short interposition graft bypass operations were performed in 13 patients with complex intracranial aneurysms. There were 6 ruptured aneurysms, including blood blister–like aneurysms in 3 patients, giant aneurysms in 2 patients, and fusiform dissecting aneurysm in 1 patient. Among 7 patients with unruptured aneurysms, there were 5 giant aneurysms and 2 large fusiform aneurysms in the M2 segment. Results Parent artery occlusion with endovascular coiling (3 patients) or trapping by direct clipping (10 patients) was used to treat complex cerebral aneurysms. Complete occlusion of the aneurysm was demonstrated in 11 patients (85%); the other 2 patients did not demonstrate occlusion immediately postoperatively. Except for 2 patients who presented with poor-grade subarachnoid hemorrhage, patients ( n  = 11; 85%) demonstrated good scores on the Glasgow Outcome Scale. No new neurologic deficits developed in relation to insufficient blood flow through the bypass graft. In all 13 patients, graft patency was good at long-term follow-up (overall mean follow-up, 28.2 months). Conclusions Superficial temporal artery–middle cerebral artery bypass surgery using a short interposition graft for intracranial complex aneurysms seems to be safe and efficient hemodynamically after occlusion of the parent artery. It could be regarded as a good alternative to high-flow bypass surgery.