Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Neurosurg Rev. 2021 Apr;44(2):905-914. doi: 10.1007/s10143-020-01302-6. Epub 2020 Apr 21.
To perform a systematic review of extracranial-to-intracranial (EC-IC) bypass surgery with parent vessel trapping for blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) according to PRISMA guidelines. Search of PubMed using "bypass" [all fields] and "ICA" [all fields] or "internal carotid artery" [all fields] and ("blood blister-like aneurysm" [MeSH terms]. Thirty-four original articles were identified, of which 21 were excluded (treatment not including bypass or insufficient details on complications or clinical outcomes). Thirteen articles published between 2008 and 2019 were included, totaling 98 patients, with a median of 7.5 patients per article (range 1-17). Mean age was 53.3 years (range 23-80). The main techniques were external carotid artery to middle cerebral artery (ECA-MCA) in 81% and superficial temporal artery to MCA (STA-MCA) in 19%. The most common grafts were radial artery (74%) and STA (19%). The risk of intraoperative rupture varied from 0 to 75%, with a mean of 12%. With respect to clinical outcomes, the modified Rankin Scale (mRS) was not stated in 30% of the cases. When stated, mRS was ≤ 2 in 79%, mRS was 3-5 in 10%, and 4% had mRS 6 (death). We identified only 13 articles, with no prospective studies. Outcomes were better than generally reported for ruptured aneurysms, both with respect to poor outcome (mRS > 2) and in-hospital mortality, perhaps reflecting a selection bias. In general, the data reporting quality was low, precluding any firm conclusions, but EC-IC bypass with ICA trapping may be a valid treatment option for ruptured ICA BBAs.
根据 PRISMA 指南，对颅外-颅内（EC-IC）旁路手术伴颈内动脉（ICA）血疱样动脉瘤（BBA）母血管夹闭进行系统评价。在 PubMed 中使用“bypass”[所有字段]和“ICA”[所有字段]或“internal carotid artery”[所有字段]和（“blood blister-like aneurysm”[MeSH 术语]进行搜索。共确定了 34 篇原始文章，其中 21 篇被排除（治疗不包括旁路或并发症或临床结果的详细信息不足）。纳入了 2008 年至 2019 年期间发表的 13 篇文章，共 98 例患者，中位数为每篇文章 7.5 例（范围为 1-17 例）。平均年龄为 53.3 岁（范围为 23-80 岁）。主要技术为颈外动脉-大脑中动脉（ECA-MCA）81%和颞浅动脉-大脑中动脉（STA-MCA）19%。最常见的移植物为桡动脉（74%）和 STA（19%）。术中破裂风险从 0 到 75%不等，平均为 12%。关于临床结果，30%的病例未报告改良 Rankin 量表（mRS）。当报告时，79%的 mRS≤2，10%的 mRS 为 3-5，4%的 mRS 为 6（死亡）。我们仅发现 13 篇文章，均无前瞻性研究。结果优于一般报道的破裂动脉瘤，无论是不良结局（mRS＞2）还是住院死亡率，这可能反映了选择偏倚。总体而言，数据报告质量较低，无法得出任何确定的结论，但颈内动脉夹闭伴颅外-颅内旁路手术可能是破裂颈内动脉 BBA 的有效治疗选择。
