Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Department of Neurosurgery, The First Affiliated Hospital of University of South China, Hengyang, China; Arkansas Neuroscience Institute, St. Vincent Hospital, Little Rock, Arkansas, USA.
World Neurosurg. 2019 May;125:285-298. doi: 10.1016/j.wneu.2019.01.259. Epub 2019 Feb 18.
Intracranial-intracranial (IC-IC) bypass with a graft vessel (IBGV) is a straightforward arterial reconstruction technique used for the treatment of complex aneurysms and skull base tumors. We have described the technical characteristics and summarized the clinical results of IBGV in complex cerebrovascular disorders.
We performed a search of the PubMed and Google Scholar online databases. The terms "intracranial-intracranial bypass," "jump graft bypass," "interposition graft bypass," "radial artery graft bypass," "saphenous vein graft bypass," and "superficial temporal artery graft bypass" were searched. Studies involving IBGV combined with other bypass methods were excluded. Illustrations of the technique have been provided to enhance comprehension.
We identified 59 cases involving 6 types of graft vessels were identified from 1978 to July 2018. The IBGV technique was divided into the following 4 subtypes: type IA, in situ interposition graft bypass; type IB, Y-shaped double-barrel interposition graft bypass; type IIA, long jump graft bypass; and type IIB, Y-shaped double-barrel jump graft bypass. Grafts from the radial (44.1%; 26 of 59) and superficial temporal (39.3%; 22 of 59) arteries were used most frequently, and the middle cerebral artery territory was the most commonly involved region for IBGV. Of the cases with the specified postoperative characteristics, the graft patency and overall uneventful rates were 96.3% (52 of 54) and 82.2% (37 of 45), respectively. A higher patency rate (100% vs. 90.5%) and a lower complication rate (<20% vs. 60%) were observed with the type II group with an arterial graft.
The IBGV method is a technically feasible option for vascular disease or complex cerebral tumors and should be considered by neurosurgeons. Long jump bypass with arterial grafts should be preferred when IC-IC bypass has been considered owing to the high rates of graft patency and favorable clinical outcomes.
带移植物血管的颅内外（IC-IC）旁路是一种用于治疗复杂动脉瘤和颅底肿瘤的直捷动脉重建技术。我们描述了该技术的特点，并总结了带移植物血管的 IC-IC 旁路在复杂脑血管疾病中的临床结果。
我们在 PubMed 和 Google Scholar 在线数据库中进行了检索。检索词为“颅内-颅外旁路”、“跳跃移植物旁路”、“间置移植物旁路”、“桡动脉移植物旁路”、“大隐静脉移植物旁路”和“颞浅动脉移植物旁路”。排除了涉及带移植物血管的 IC-IC 旁路与其他旁路方法相结合的研究。我们提供了该技术的示意图以增强理解。
我们从 1978 年至 2018 年 7 月共发现 59 例涉及 6 种移植物血管的病例。IC-IC 旁路技术分为以下 4 种亚型：IA 型，原位间置移植物旁路；IB 型，Y 型双腔间置移植物旁路；IIA 型，长跳跃移植物旁路；和 IIB 型，Y 型双腔跳跃移植物旁路。最常使用桡动脉（44.1%；59 例中有 26 例）和颞浅动脉（39.3%；59 例中有 22 例）作为移植物血管，IC-IC 旁路最常涉及大脑中动脉区域。在指定了术后特征的病例中，移植物通畅率和总体无并发症率分别为 96.3%（54 例中有 52 例）和 82.2%（45 例中有 37 例）。动脉移植物的 II 型组显示出更高的通畅率（100%比 90.5%）和更低的并发症率（<20%比 60%）。
带移植物血管的 IC-IC 旁路方法对于血管疾病或复杂脑肿瘤是一种可行的技术选择，神经外科医生应考虑采用该方法。当考虑进行 IC-IC 旁路时，由于移植物通畅率高且临床结果良好，应首选动脉移植物的长跳跃旁路。
