Neurosurgery Blog: Revascularization and Aneurysm Surgery: Techniques, Indications, and Outcomes in the Endovascular Era

Wednesday, April 23, 2014

Revascularization and Aneurysm Surgery: Techniques, Indications, and Outcomes in the Endovascular Era

Neurosurgery - Current Issue

BACKGROUND: Given advances in endovascular technique, the indications for revascularization in aneurysm surgery have declined. OBJECTIVE: We sought to define indications, outline technical strategies, and evaluate the outcomes of patients treated with bypass in the endovascular era. METHODS: We retrospectively reviewed all aneurysms treated between September 2006 and February 2013. RESULTS: We identified 54 consecutive patients (16 males and 39 females) with 56 aneurysms. Aneurysms were located along the cervical internal carotid artery (ICA) (n = 1), petrous/cavernous ICA (n = 1), cavernous ICA (n = 16), supraclinoid ICA (n = 7), posterior communicating artery (n = 2), anterior cerebral artery (n = 4), middle cerebral artery (MCA) (n = 13), posterior cerebral artery (PCA) (n = 3), posterior inferior cerebellar artery (n = 4), and vertebrobasilar arteries (n = 5). Revascularization was performed with superficial temporal artery (STA) to MCA bypass (n = 25), STA to superior cerebellar artery (SCA) (n = 3), STA to PCA (n = 1), STA-SCA/STA-PCA (n = 1), occipital artery (OA) to PCA (n = 2), external carotid artery/ICA to MCA (n = 15), OA to MCA (n = 1), OA to posterior inferior cerebellar artery (n = 1), and in situ bypasses (n = 8). At a mean clinical follow-up of 18.5 months, 45 patients (81.8%) had a good outcome (Glasgow Outcome Scale 4 or 5). There were 7 cases of mortality (12.7%) and an additional 9 cases of morbidity (15.8%). At a mean angiographic follow-up of 17.8 months, 14 bypasses were occluded. Excluding the 7 cases of mortality, the majority of aneurysms (n = 42) were obliterated. We identified 7 cases of residual aneurysm and recurrence in 6 patients at follow-up. CONCLUSION: Given current limitations with existing treatments, cerebral revascularization remains an essential technique for aneurysm surgery. ABBREVIATIONS: ACA, anterior cerebral artery aSAH, aneurysmal subarachnoid hemorrhage BTO, balloon test occlusion GOS, Glasgow Outcome Scale ICA, internal carotid artery MCA, middle cerebral artery OA, occipital artery PCA, posterior cerebral artery PComm, posterior communicating artery PICA, posterior inferior cerebellar artery SCA, superior cerebellar artery STA, superficial temporal artery

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/05000/Revascularization_and_Aneurysm_Surgery__.4.aspx