Anterior Cerebral Artery Bypass for Complex Aneurysms: Advances in Intracranial-Intracranial Bypass Techniques.
World Neurosurg
; 141: e42-e54, 2020 09.
Article
em En
| MEDLINE
| ID: mdl-32360674
ABSTRACT
BACKGROUND:
Anterior cerebral artery (ACA) bypasses for complex aneurysms are infrequently performed, yet previous experience demonstrates the importance of intracranial-intracranial bypasses. Here we describe technical advances in intracranial-intracranial bypass techniques and their clinical results.METHODS:
Twenty-three patients with complex aneurysms requiring ACA bypasses were retrospectively studied. Ten patients were treated in period 1 (1997-2013) and 13 in period 2 (2014-2018).RESULTS:
There were 3 precommunicating, 8 communicating, and 8 postcommunicating ACA aneurysms, plus 4 middle cerebral artery aneurysms. ACA in situ bypass was the most commonly performed (9 patients; 39%). The classic left A3 ACA-right A3 ACA in situ bypass was performed in 5 patients, but 3 new in situ variations emerged in period 2 left pericallosal artery (PcaA)-right PcaA (n = 1), left callosomarginal artery (CmaA)-right CmaA (n = 2), and left CmaA-right A3 ACA (n = 1). The sole reimplantation in period 1 was the ipsilateral and vertical PcaA-CmaA reimplantation, whereas reimplantations in period 2 were contralateral and horizontal (left PcaA-right PcaA and right A3 ACA-left anterior internal frontal artery). The A1 ACA was used as a donor only in period 2 in 4 patients with middle cerebral artery bifurcation aneurysms. Bypass patency was 91%, and 21 patients (91%) improved or remained at neurologic baseline (mean [standard deviation] follow-up duration, 26 [8.2] months).CONCLUSIONS:
ACA bypass techniques continue to evolve with the addition of several variations. These variations push bypass techniques beyond the standard constructs and add important alternatives to our bypass arsenal.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Aneurisma Intracraniano
/
Revascularização Cerebral
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article