21 年经验总结：颅内旁路手术的实践趋势。
Practice Trends in Intracranial Bypass Surgery in a 21-Year Experience.
机构信息
Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA; Department of Neurosurgery, Baylor College of Medicine Medical Center, Houston, Texas, USA.
Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
出版信息
World Neurosurg. 2019 May;125:e717-e722. doi: 10.1016/j.wneu.2019.01.161. Epub 2019 Feb 6.
OBJECTIVE
The aim of this study was to analyze practice trends in specific intracranial bypass types in a large, consecutive bypass experience.
METHODS
This retrospective review of a prospectively maintained database included all intracranial bypasses performed by a single surgeon over 21 years. Bypass types were grouped into 7 categories and analyzed in seven 3-year time intervals: type 1 = extracranial-to-intracranial (EC-IC) bypass with scalp arteries as donors; type 2 = EC-IC bypass with interposition graft to cervical carotid arteries; type 3 = arterial reimplantation; type 4 = in situ bypass; type 5 = reanastomosis; type 6 = intracranial-to-intracranial bypass with interposition graft; and type 7 = combination bypass.
RESULTS
In total, 598 intracranial bypasses were performed including 359 type 1, 59 type 2, 24 type 3, 30 type 4, 37 type 5, 36 type 6, and 53 type 7. Although type 1 and type 3-7 bypasses increased, type 2 bypasses decrease in frequency. Aneurysms were the most common bypass indication (41.8%), followed by moyamoya disease (31.8%), and intracranial arterial stenosis or occlusion (24.9%). Endovascular treatment failure was observed in 10.8% of the aneurysm patients treated with a bypass procedure.
CONCLUSIONS
Intracranial bypass remains an essential technique for open vascular neurosurgeons. The classic low-flow EC-IC bypasses, intracranial-to-intracranial, and combination bypasses increased over time, whereas the high-flow EC-IC interpositional bypasses decreased over time. These trends reflect the increasing use of flow diverters as well as the need for surgical revascularization for complex aneurysms, and those that failed previous endovascular therapy.
目的
本研究旨在分析在一项大型连续旁路经验中特定颅内旁路类型的实践趋势。
方法
这是对一位外科医生在 21 年内进行的前瞻性维护数据库的回顾性研究。将旁路类型分为 7 类，并在 7 个 3 年时间间隔内进行分析：1 型=头皮动脉作为供体的颅外-颅内（EC-IC）旁路；2 型=颈内颈动脉的 EC-IC 旁路带间位移植物；3 型=动脉再植入；4 型=原位旁路；5 型=再吻合；6 型=颅内-颅内旁路带间位移植物；7 型=组合旁路。
结果
共进行了 598 例颅内旁路手术，其中 359 例 1 型、59 例 2 型、24 例 3 型、30 例 4 型、37 例 5 型、36 例 6 型和 53 例 7 型。虽然 1 型和 3-7 型旁路手术的数量增加，但 2 型旁路手术的数量减少。动脉瘤是最常见的旁路适应证（41.8%），其次是 moyamoya 病（31.8%）和颅内动脉狭窄或闭塞（24.9%）。在接受旁路手术治疗的动脉瘤患者中，有 10.8%的患者出现血管内治疗失败。
结论
颅内旁路仍然是开放血管神经外科医生的一项重要技术。经典的低流量 EC-IC 旁路、颅内-颅内和组合旁路随着时间的推移而增加，而高流量 EC-IC 间位旁路则随着时间的推移而减少。这些趋势反映了流量分流器的使用增加，以及对复杂动脉瘤和那些先前血管内治疗失败的患者进行手术再血管化的需求。
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