Gazyakan Emre, Lee Ching-Yi, Wu Chieh-Tsai, Tsao Chung-Kan, Craft Randall, Henry Steven L, Cheng Ming-Huei, Lee Shih-Tseng
Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex.
Plast Reconstr Surg Glob Open. 2015 May 7;3(4):e372. doi: 10.1097/GOX.0000000000000339. eCollection 2015 Apr.
Extracranial-to-intracranial (EC-IC) arterial bypass is a technically demanding procedure used to treat complex cerebral artery diseases. The indications, proper surgical techniques, and outcomes of this procedure have been under debate over the recent decades.
Between January 2004 and December 2012, 28 patients, including patients with cerebral artery occlusion, intracranial aneurysm, cranial base tumor, and Moyamoya disease, underwent EC-IC bypass. Patients' records were retrospectively reviewed for demography, indications, complications, high-flow versus low-flow bypass, patency rate of bypass, and neurological outcome. The patients were sorted into prophylactic (n = 16) and therapeutic (n = 12) groups based on the preoperative presentation of their neurological symptoms. Follow-up evaluation was performed at a mean of 32.7 ± 24.3 months.
The overall patency rate of bypass was 100%, the postoperative stroke rate was zero, and the surgical complication rate was 14.3%. There was no significant difference in the bypass patency rate between the 2 groups or between the high-flow and low-flow bypass patients. Patients who underwent prophylactic bypass had minimal surgical and total complications (P = 0.03 and P < 0.01, respectively) and a better neurological outcome. Surgical complications were more common in patients who underwent therapeutic bypass (25%).
The collaboration of neurosurgeons and plastic surgeons in performing EC-IC bypass can result in excellent outcomes with a high bypass patency rate and few complications, particularly for prophylactic EC-IC bypass.
颅外-颅内（EC-IC）动脉搭桥术是一种技术要求较高的手术，用于治疗复杂的脑动脉疾病。近几十年来，该手术的适应症、合适的手术技术及手术效果一直存在争议。
2004年1月至2012年12月期间，28例患者接受了EC-IC搭桥术，其中包括脑动脉闭塞、颅内动脉瘤、颅底肿瘤和烟雾病患者。对患者的记录进行回顾性分析，内容包括人口统计学资料、适应症、并发症、高流量与低流量搭桥、搭桥通畅率及神经功能结局。根据术前神经症状表现将患者分为预防性（n = 16）和治疗性（n = 12）两组。平均随访32.7±24.3个月。
搭桥总体通畅率为100%，术后卒中率为零，手术并发症发生率为14.3%。两组之间或高流量与低流量搭桥患者之间的搭桥通畅率无显著差异。接受预防性搭桥的患者手术并发症和总并发症最少（分别为P = 0.03和P < 0.01），神经功能结局更好。治疗性搭桥患者的手术并发症更常见（25%）。
神经外科医生和整形外科医生合作进行EC-IC搭桥术可取得良好效果，搭桥通畅率高且并发症少，尤其是预防性EC-IC搭桥术。
