In situ interposition bypass surgery in treatment of complex intracranial aneurysm: a report of 18 cases / 中华显微外科杂志

ABSTRACT

Objective:To investigate the application of in situ interposition bypass surgery in the treatment of complex intracranial aneurysms.Methods:A retrospective analysis was conducted on the clinical data of 18 patients with complex intracranial aneurysms treated by the in situ interposition bypass at the Department of Neurosurgery of Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University from July 2015 to September 2022. Fourteen aneurysms were found being located in the middle cerebral artery(MCA), 2 in anterior cerebral artery(ACA), 1 in posterior inferior cerebellar artery(PICA) and 1 in posterior cerebral artery(PCA). Fourteen bypass surgery were with radial artery(RA) vessel grafts, 3 with superficial temporal artery(STA) vessel grafts and 1 with occipital artery(OA) vessel graft. All patients underwent a surgical procedure of in situ interposition bypass with end-to-end anastomosis after resection of the aneurysms. I-type grafts were applied in 13 bypasses, V-type grafts in 3 bypasses, and Y-type grafts in 2 bypasses. All patients had undergone postoperative Digital subtraction angiography(DSA) or CTA reviews. Glasgow Outcome Scale(GOS) was used to assess postoperative outcome. Scheduled postoperative follow-ups were conducted on all patients.Results:Two patients suffered hemiplegia after surgery. One patient had transient aphasia and it recovered in 3 months. No new neurological dysfunction was observed in the rest of patients. Postoperative DSAs showed good patency of the anastomoses and grafted vessels, except one anastomosis that had a severe stenosis, and no aneurysm was shown. The follow-ups lasted for 3 to 89 months and no recurrence of aneurysm was observed. Sixteen patients achieved GOS score 5 and 2 with GOS score 3.Conclusion:In situ interposition bypass surgery is a safe and effective procedure for the treatment of complex intracranial aneurysms.