Quiñones-Hinojosa Alfredo, Lawton Michael T
Department of Neurological Surgery, Center for Stroke and Cerebrovascular Disease, University of California, San Francisco, San Francisco, California 94143-0112, USA.
Neurosurgery. 2008 Jun;62(6 Suppl 3):1442-9. doi: 10.1227/01.neu.0000333808.64530.dd.
Cerebral revascularization is an important part of the treatment of complex intracranial aneurysms that require deliberate occlusion of a parent artery. In situ bypass brings together intracranial donor and recipient arteries that lie parallel and in close proximity to one another rather than using an extracranial donor artery. An experience with in situ bypasses was retrospectively reviewed.
Thirteen aneurysms were treated with in situ bypasses between 1997 and 2004. During this time, 1071 aneurysms were treated microsurgically and 46 bypasses were performed as part of the aneurysm treatment.
Treated aneurysms were located at the middle cerebral artery (MCA) in five patients, posteroinferior cerebellar artery (PICA) in three patients, vertebral artery in three patients, and anterior communicating artery in two patients. Seven aneurysms were fusiform or dolichoectatic, and six aneurysms were saccular. Microsurgical revascularization techniques included side-to-side anastomosis of intracranial arteries in eight patients and aneurysm excision with end-to-end reanastomosis of the parent artery in five patients. In situ bypasses included A3-A3 anterior cerebral artery bypass in two patients, anterior temporal artery-MCA bypass in one patient, MCA-MCA bypass in one patient, and PICA-PICA bypass in four patients. Aneurysm excision with arterial reanastomosis included three MCA aneurysms and two PICA aneurysms. On angiography, all aneurysms were completely obliterated and 12 bypasses were patent.
In situ bypass is a safe and effective alternative to extracranial-intracranial bypasses and high-flow bypasses using saphenous vein or radial artery grafts. Although in situ bypasses are more demanding technically, they do not require harvesting a donor artery, can be accomplished with one anastomosis, and are less vulnerable to injury or occlusion.
脑血运重建是治疗复杂颅内动脉瘤的重要组成部分，这类动脉瘤需要对载瘤动脉进行选择性闭塞。原位搭桥是将相互平行且紧邻的颅内供体动脉和受体动脉连接在一起，而不是使用颅外供体动脉。对原位搭桥的经验进行了回顾性分析。
1997年至2004年间，13例动脉瘤采用原位搭桥治疗。在此期间，1071例动脉瘤接受了显微手术治疗，46例搭桥作为动脉瘤治疗的一部分进行。
治疗的动脉瘤位于大脑中动脉（MCA）5例，小脑后下动脉（PICA）3例，椎动脉3例，前交通动脉2例。7例动脉瘤为梭形或迂曲扩张型，6例为囊状。显微手术血运重建技术包括8例患者的颅内动脉端侧吻合和5例患者的动脉瘤切除及载瘤动脉端端再吻合。原位搭桥包括2例患者的A3 - A3大脑前动脉搭桥，1例患者的颞前动脉 - MCA搭桥，1例患者的MCA - MCA搭桥，4例患者的PICA - PICA搭桥。动脉瘤切除及动脉再吻合包括3例MCA动脉瘤和2例PICA动脉瘤。血管造影显示，所有动脉瘤均完全闭塞且12例搭桥通畅。
原位搭桥是颅外 - 颅内搭桥以及使用大隐静脉或桡动脉移植物的高流量搭桥的一种安全有效的替代方法。尽管原位搭桥在技术上要求更高，但它不需要获取供体动脉，可通过一次吻合完成，且不易受到损伤或闭塞。
