Biswas Arundhati, Samadoni A El, Elbassiouny Ahmed, Sobh Khaled, Hegazy Ahmed
Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Department of Vascular Surgery, Cairo University, Giza, Egypt.
Asian J Neurosurg. 2015 Oct-Dec;10(4):303-9. doi: 10.4103/1793-5482.162711.
Cerebral revascularization is a useful microsurgical technique for the treatment of steno-occlusive intracranial ischemic disease, complex intracranial aneurysms that require deliberate occlusion of a parent artery and invasive skull base tumors. We describe our preliminary experience with extracranial-to-intracranial by-passes at a low volume center; and discuss clinical indications and microsurgical techniques, challenges in comparison to large advanced referral centers.
Twenty-seven patients with hemodynamic ischemia or complex aneurysms or skull base tumors were operated at Cairo University Hospitals in the period between May 2009 and June 2014. All patients operated by a low flow by-pass were operated through a superficial temporal artery to middle cerebral artery (MCA) anastomosis. All patients chosen for a high flow by-pass were operated using a radial artery graft interposed between the MCAs distally and the common or the external carotid artery proximally. Patency was confirmed at the end of surgery using appearance on the table and confirmed after surgery by transcranial color-coded duplex or computed tomography angiography. All patient data were prospectively collected and retrospectively analyzed at the end of surgery.
Nineteen patients (70.4%) were operated upon for flow augmentation and eight patients (29.6%) were operated upon for flow replacement. A total of 30 anastomoses were performed. All except one were patent which gives a patency rate of 96.3%. There was one death in the present series resulting from a hyperperfusion syndrome. 89.5% of patients with hemodynamic ischemia stopped having symptoms after surgery. All but one patient operated for hemodynamic ischemia showed a considerable cognitive improvement after surgery. None of the patients operated upon for flow replacement showed improvement of oculomotor nerve function in spite of adequate intraoperative decompression. All patients treated for flow replacement showed the absence of recurrence on follow-up.
Our initial results for both low and high flow by-pass procedures in our low volume center indicate that such complex surgical procedures are possible with results comparable to those obtained in other larger referral centers throughout the world. This procedure not only represents a more definitive treatment when compared to other endovascular or radiation treatments but is also much less costly when compared to other treatment modalities.
脑血运重建术是一种用于治疗颅内狭窄闭塞性缺血性疾病、需要特意闭塞供血动脉的复杂颅内动脉瘤以及侵袭性颅底肿瘤的有用显微外科技术。我们描述了在一个低容量中心进行颅外-颅内旁路手术的初步经验；并讨论了临床适应症、显微外科技术以及与大型高级转诊中心相比所面临的挑战。
2009年5月至2014年6月期间，开罗大学医院对27例患有血流动力学缺血、复杂动脉瘤或颅底肿瘤的患者进行了手术。所有接受低流量旁路手术的患者均通过颞浅动脉至大脑中动脉（MCA）吻合术进行手术。所有选择进行高流量旁路手术的患者均使用桡动脉移植物，该移植物远端置于大脑中动脉之间，近端置于颈总动脉或颈外动脉。手术结束时通过手术台上的外观确认通畅情况，术后通过经颅彩色编码双功超声或计算机断层血管造影进行确认。所有患者数据均在手术结束时进行前瞻性收集并回顾性分析。
19例（70.4%）患者接受了血流增加手术，8例（29.6%）患者接受了血流置换手术。共进行了30次吻合。除1例之外全部通畅，通畅率为96.3%。本系列中有1例因高灌注综合征死亡。89.5%的血流动力学缺血患者术后症状消失。除1例接受血流动力学缺血手术的患者外，所有患者术后认知功能均有显著改善。尽管术中进行了充分减压，但所有接受血流置换手术的患者动眼神经功能均未改善。所有接受血流置换治疗的患者随访时均未出现复发。
我们低容量中心低流量和高流量旁路手术的初步结果表明，这种复杂的外科手术是可行的，其结果与世界其他较大转诊中心所获得的结果相当。与其他血管内或放射治疗相比，该手术不仅是一种更具确定性的治疗方法，而且与其他治疗方式相比成本也低得多。
