Strickland Ben A, Rennert Robert C, Bakhsheshian Joshua, Bulic Sebina, Correa Adrian J, Amar Arun, Carey Joseph, Russin Jonathan J
Departments of1Neurosurgery.
2Department of Neurosurgery, University of California at San Diego, California.
J Neurosurg. 2018 Mar 2;130(2):566-572. doi: 10.3171/2017.9.JNS171292. Print 2019 Feb 1.
Surgical revascularization continues to play an important role in the management of complex intracranial aneurysms and ischemic cerebrovascular disease. Graft spasm is a common complication of bypass procedures and can result in ischemia or graft thrombosis. The authors here report on the first clinical use of botulinum toxin to prevent graft spasm following extracranial-intracranial (EC-IC) bypass. This technique was used in 3 EC-IC bypass surgeries, 2 for symptomatic carotid artery occlusions and 1 for a ruptured basilar tip aneurysm. In all 3 cases, the harvested graft was treated ex vivo with botulinum toxin before the anastomosis was performed. Post-bypass vascular imaging demonstrated patency and the absence of spasm in all grafts. Histopathological analyses of treated vessels did not show any immediate endothelial or vessel wall damage. Postoperative angiograms were without graft spasm in all cases. Botulinum toxin may be a reasonable option for preventing graft spasm and maintaining patency in cerebral revascularization procedures.
外科血管重建术在复杂颅内动脉瘤和缺血性脑血管疾病的治疗中继续发挥着重要作用。移植血管痉挛是搭桥手术的常见并发症，可导致缺血或移植血管血栓形成。本文作者报告了肉毒杆菌毒素预防颅外-颅内（EC-IC）搭桥术后移植血管痉挛的首次临床应用。该技术用于3例EC-IC搭桥手术，2例用于有症状的颈动脉闭塞，1例用于破裂的基底动脉尖动脉瘤。在所有3例手术中，采集的移植血管在进行吻合术前在体外用肉毒杆菌毒素处理。搭桥术后血管成像显示所有移植血管通畅且无痉挛。对处理过的血管进行组织病理学分析未发现任何即时的内皮或血管壁损伤。所有病例术后血管造影均未出现移植血管痉挛。肉毒杆菌毒素可能是预防移植血管痉挛和维持脑血运重建手术中血管通畅的合理选择。
