gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, 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

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc138.shtml

Published: May 8, 2006

© 2006 Kayama et al.
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Outline

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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.