Revascularization in the Management of Complex Cerebral Aneurysm / 대한뇌혈관외과학회지

The objective of aneurysm surgery is to exclude the aneurysm from the circulation while preserving blood flow distal to the lesion. In certain situations, the aneurysm neck cannot be clipped safely or the parent vessel reconstructed, primarily in large or giant size with incorporation of parent vessels or perforating arteries, calcification at the aneurysm base, and fusiform or dissecting aneurysms. In such cases, occlusion of the parent vessel is a treatment of option. In many patients, however, sacrifice of the parent artery has an associated risk of ischemic stroke. Therefore, sacrifice of the parent vessel can be supplimented with distal revascularization to provide the necessary distal blood flow while allowing the aneurysm to be trapped. The indications, options, and surgical approaches are described with review of literatures. Finally the authors' experiences of revascularization in 7 patients with unclippable aneurysms are reported.

Bypass Graft for Cerebral Revascularization / 대한뇌혈관학회지

OBJECTIVE: The authors were performed bypass graft for cerebral revascularization in the treatment of hemodynamic cerebral ischemia and unclippable traumatic aneurysm, which acute sacrifice of the internal carotid artery is necessary. The aim of this study was to assess effectiveness bypass graft for cerebral revascularization. METHOD: Of 6 patients, Four patients were hemodynamic cerebral ischemia and two patients were traumatic cerebral aneurysm and traumatic carotid-cavernous fistula (CCF). Revascularization was performed external carotid artery (ECA) to middle cerebral artery (MCA) bypass with radial artery (n=1), ECA to MCA bypass with long saphenous vein (n=1), main trunk of superficial temporal artery (STA) to MCA with short saphenous vein (n=2), and internal carotid artery (ICA) to MCA with long saphenous vein (n=2). RESULTS: There were two graft occlusion, which one is recanalization case of preoperative MCA obstruction and the other is traumatic CCF. Four patients with good patiency through bypass showed significant increase of postoperative cerebral blood flow and good surgical outcome. There was not operative complication except for graft failure of 2 cases. CONCLUSION: Extracranial to intracranial bypass graft with radial artery or saphenous vein is thought to alternative method for cerebral revascularization in cases with unsuitable STA to bypass, and ICA reconstruction, which acute sacrifice of ICA is necessary.