gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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

Meeting Abstract

  • presenting/speaker Angelo Tortora - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Athanasios Petridis - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Hans-Jakob Steiger - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Jan Frederick Cornelius - Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP133

doi: 10.3205/19dgnc469, urn:nbn:de:0183-19dgnc4692

Veröffentlicht: 8. Mai 2019

© 2019 Tortora et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

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.