Document Detail


Cerebral Bypasses for Complex Aneurysms and Tumors: Long-Term Results and Graft Management Strategies.
MedLine Citation:
PMID:  22278357     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Various techniques of cerebral bypasses are used in the treatment of aneurysms and tumors. OBJECTIVE: To study long-term clinical and radiological outcome of various bypass types, and analyze techniques used in the management of long-term graft problems. METHODS: A consecutive series of patients who underwent revascularization during a five-year period was analyzed for indications, graft patency, and neurological outcomes. Potential risk factors for bypass problems and the management of bypass stenosis were studied. RESULTS: A total of 80 patients (69 aneurysms and 11 tumors) underwent 88 bypasses [59 extracranial-to-intracranial (EC-IC) bypasses {10 low-flow, 49 high-flow}, 9 intracranial-to-intracranial (IC-IC) bypasses{3 long and 6 short} and 20 local bypasses], with mean radiological follow-up of 32 months (range 1-53). At late follow-up, 5 of 9 (56%) IC-IC (5 short and none of the long grafts), 8 of 9 (90%) EC-IC LF and 44 of 48 (92%) EC-IC (HF), and all local bypasses were patent. Four patients with EC-IC (HF) bypass occlusions were asymptomatic, but TIAs were noted in 3/6 patients with graft stenosis. None of the risk factors evaluated were significantly predictive of EC-IC graft occlusions or stenosis. EC-IC HF graft stenoses were permanently corrected by microsurgery (n=4) or endovascular surgery (n=1). CONCLUSION: EC-IC and local bypasses have higher long-term patency rates (91% and 100 %) compared to IC-IC bypasses (66%, 0% long graft). Some EC-IC bypasses may occlude asymptomatically (9%) or develop graft stenosis (13%) over the long-term. Microsurgical and endovascular surgical techniques have been developed to treat graft stenosis.
Authors:
Dinesh Ramanathan; Nancy Temkin; Louis J Kim; Basavaraj Ghodke; Laligam N Sekhar
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-24
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Neurological Surgery, University of Washington, Seattle 2Department of Biostatistics, University of Washington, Seattle.
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