gms | German Medical Science

Objective: Arterial occlusion during neuro-oncological procedures is a feared complication. While some cortical vessels feeding non-eloquent brain regions or having leptomeningeal collateralization may be sacrificed without resulting neurological deficits, occlusion of small perforators and major vessels usually results in infarction. EC-IC and IC-IC reconstruction techniques can restore blood flow in non-perforating cerebral or cerebellar arteries. We present a series of 3 patients treated with bypass surgery after spontaneous or iatrogenic irreversible arterial occlusion during resection of a malignant brain tumor.

Methods: The data were retrieved from our database of patients treated with cerebral revascularization between January 2016 and August 2019. Only patients with a malignant brain tumor were included.

Results: Between January 2016 and August 2019 we performed 3 revascularizations on patients with malignant brain tumor. A double barrel end-to-end superficial temporal artery to medial cerebral artery anastomosis was performed on insular segment (M2) of a patient with insular WHO IV glioma and spontaneous thrombosis of the middle cerebral artery’s main bifurcation. The patient underwent subtotal tumor resection after the bypass in the same procedure. A double barrel EC-IC end-to-end bypass using the occipital artery as donor was constructed after symptomatic occlusion of M1 on a previously operated WHO III glioma patient with exophytic cisternal growth pattern. The recipient arteries were found on cortical M4 branches of MCA. In a third patient with a sylvian metastasis, we created a double IC-IC bypass after an injury of the superior trunk´s first bifurcation that was encased in a tumor with hard consistence . The bypass consisted of an end to end and an end to side anastomosis. All procedures were successful. Bypass patency was postoperatively confirmed by imaging without evidence of infarction in the revascularized territories.

Conclusion: Cerebral revascularization for neuro-oncological patients with malignant tumors is a safe procedure in high volume centers where bypass surgery is routinely performed. Positive clinical outcome in our small series encourages aggressive resection even in tumors adherent to or infiltrating major vessels.