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

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Extra-intracranial high-flow bypasses for symptomatic internal carotid artery aneurysms

Extra-intrakranielle High-Flow-Bypässe als Therapieoption symptomatischer Arteria-cerebri-interna-Aneurysmen

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  • corresponding author J. Rohlfs - Klinik für Neurochirurgie, Philipps-Universität Marburg
  • U. Sure - Klinik für Neurochirurgie, Philipps-Universität Marburg
  • O. Sürücü - Klinik für Neurochirurgie, Philipps-Universität Marburg
  • L. Benes - Klinik für Neurochirurgie, Philipps-Universität Marburg
  • R.G. Moosdorf - Klinik für Herz- und thorakale Gefäßchirurgie, Philipps-Universität Marburg
  • H. Bertalanffy - Klinik für Neurochirurgie, Philipps-Universität Marburg

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. DocFR.05.04

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc028.shtml

Published: May 8, 2006

© 2006 Rohlfs et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: A review of the literature shows that the treatment of patients with symptomatic unclippable and uncoilable carotid artery aneurysms is uncommon. In patients with insufficient cross flow, in which occlusion of the internal carotid artery (ICA) alone is not possible, additional placement of a high-flow bypass may be necessary. We report on our experience with 5 patients, who underwent such a treatment in order to exclude a large or giant ICA-aneurysm from the blood circulation.

Methods: Four patients had large infraclinoidal ICA aneurysms and one individual, a giant supraophthalmic ICA aneurysm. Angiography furnished evidence of an insufficient cross flow of the communicating arteries in all patients. In three cases, a radial artery graft and in the remaining two a saphenous vein graft were implanted. The grafts were either interposed between the external carotid artery and the medial cerebral artery (four patients) or between the proximal and distal ICA (one patient).

Results: Four of the five grafts remained patent over time. At follow-up (mean: 53,8 months), 4 patients showed a complete resolution of the preoperative ocular symptoms and neurological deficits. One patient had deteriorated during the late postoperative course.

Conclusions: High-flow bypass surgery is a reasonable and efficient treatment option for patients with large symptomatic ICA aneurysms, in whom direct clipping or interventional neuroradiological vascular remodelling is not possible. However, considering the risk of severe complications, the indication for high-flow bypass surgery and ICA-occlusion should be accurately evaluated and strictly established.