Quiñones-Hinojosa Alfredo, Du Rose, Lawton Michael T
Department of Neurological Surgery, Center for Stroke and Cerebrovascular Disease, University of California, San Francisco 94143-0112, USA.
Skull Base. 2005 May;15(2):119-32. doi: 10.1055/s-2005-870598.
Most intracranial aneurysms can be managed with either microsurgical clipping or endovascular coiling. A subset of complex aneurysms with aberrant anatomy or fusiform/dolichoectatic morphology may require revascularization as part of a strategy that occludes the aneurysm or parent artery or both. Bypass techniques have been invented to revascularize nearly every intracranial artery. An aneurysm that will require a saphenous vein bypass is one that cannot be treated with conventional microsurgical clipping or endovascular coiling and also requires deliberate sacrifice of a major intracranial artery as part of the alternative treatment strategy. In the past 7 years the senior author (MTL) has performed a total of 110 bypasses, of which 46 were for aneurysms. Twenty-two of these patients received high-flow extracranial-to-intracranial bypasses using saphenous vein grafts, of which 16 had aneurysms that were giant in size. We review the indications for saphenous vein bypasses for complex intracranial aneurysms, surgical techniques, and clinical management strategies.
大多数颅内动脉瘤可通过显微外科夹闭术或血管内栓塞术进行治疗。一部分解剖结构异常或呈梭形/迂曲扩张形态的复杂动脉瘤，作为闭塞动脉瘤或其载瘤动脉或两者的策略的一部分，可能需要进行血管重建。已经发明了多种旁路技术来对几乎每一条颅内动脉进行血管重建。需要大隐静脉旁路移植术的动脉瘤是那些无法通过传统显微外科夹闭术或血管内栓塞术治疗，并且作为替代治疗策略的一部分还需要特意牺牲一条主要颅内动脉的动脉瘤。在过去7年中，资深作者（MTL）共实施了110例旁路移植术，其中46例是针对动脉瘤的。这些患者中有22例使用大隐静脉移植物进行了高流量颅外-颅内旁路移植术，其中16例患有巨大动脉瘤。我们回顾了复杂颅内动脉瘤大隐静脉旁路移植术的适应证、手术技术及临床管理策略。
