Artikel
Emergency extracranial to intracranial (EC-IC) and intracranial to intracranial (IC-IC) revascularisation procedures. A series of 8 patients
Notfall EC-IC und IC-IC Revaskularisierungsverfahren. Eine Serie von 8 Patienten
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Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Arterial occlusion during microsurgical procedures is a rare but feared complication. EC-IC and IC-IC reconstruction techniques may restore blood flow in cerebral or cerebellar arteries. We present a series of 8 patients treated by emergency by-pass immediately after irreversible occlusion of a parent artery.
Methods: A retrospective data analysis between January 2016 and November 2018 in a tertiary care center was performed. Only emergency by-passes deemed necessary because of intraoperative occlusion of an artery were included in the study.
Results: Eight emergency revascularization procedures were performed. In 2 patients a single barrel anastomose was performed on insular segment (M3) during surgery of large media bifurcation aneurysms (1 end-to-end and 1 end-to-side). In the 3rd patient a M3 end-to-end revascularization was constructed after injury of abystander AVM vessel. In 2 cases with fusiform M2 aneurysms a double barrel IC-IC bypass (M2-M2 side-to-side and end-to-end) was realized. In one patient with a sylvian metastasis an injured superior trunk of MCA was reconstructed by end-to-side and end-to-end anastomosis on M2 branches. In 2 patients an EC-IC bypass was performed because of vascular compromise during clipping of a large ruptured Acom aneurysm (STA-A2) and during treatment of a giant M1 aneurysm (STA-M2). Unless the failure of the STA-A2 revascularization with resulting A2 infarction all other procedures were successful. By-pass patency was post-operatively confirmed by imaging (CTA/ CTP and DSA) without evidence of infarction in the re-vascularized territories.
Conclusion: During surgery of demanding neuro-oncological or -vascular pathologies the intra-operative need for arterial reconstruction may be deemed necessary. Therefore different emergent cerebral revascularization techniques should be part of the technical armamentarium of a comprehensive neurovascular team.