gms | German Medical Science

57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. bis 14.05.2006, Essen

Usefulness of high flow bypass graft for surgical treatment of clinoidal meningiomas

Meeting Abstract

  • corresponding author T. Kayama - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, JAPAN
  • S. Saito - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, JAPAN
  • S. Sato - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, JAPAN
  • R. Kondo - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, JAPAN
  • M. Saino - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, JAPAN
  • K. Sakurada - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, JAPAN
  • A. Kuge - Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, JAPAN

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSA.09.09

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2006/06dgnc138.shtml

Veröffentlicht: 8. Mai 2006

© 2006 Kayama et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: Surgical treatment of clinoidal meningiomas encasing internal carotid artery (ICA) is very difficult due to the risk of injury of the ICA and ischemic complications. We would like to discuss the necessity and indication of high flow bypass graft for surgical treatment of these tumours.

Methods: In our recent series of 210 meningiomas, 56 cases were around the clinoidal portion. Among them, ICA was encased by the tumour in 48 cases. To determine the indication for high flow bypass graft, we evaluated neurological symptoms, tumour size, MRimages, angiographic findings and ischemic tolerance due to ICA occlusion in these 48 cases. For evaluation of the ischemic tolerance, we used clinical symptoms, CBF study by SPECT and sensory evoked potentials.

Results: We performed high flow bypass graft in four cases. All four cases suffered from disturbance of visual acuity and visual fields. MRimaging disclosed parasellar mass lesions encasing ICA and extended to cavernous sinus in one case. Cerebral angiography of these cases revealed that ICA was stenotic and the feeding arteries came not only from ECA but also from ICA in each case. All four cases showed no tolerance of ischemia caused by ICA occlusion. Thus, we planed a two-stage operation. Namely the first operation was high flow ECA-ICA bypass graft surgery with saphenous vein, and the second was tumour extirpation. As a result, we could get favourable outcomes, namely maximum resection without additional neurological deficits due to ischemia.

Conclusions: To prevent ischemic complications in the patients who cannot tolerate carotid balloon occlusion test, we consider that we ought to perform bypass graft surgery before tumour resection. In this paper, we would like to discuss the indication of the EC-IC bypass surgery and strategies of tumour extirpation for the meningiomas affecting carotid systems.