Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Neurosurgery, University of California San Diego, San Diego, CA, USA.
World Neurosurg. 2021 Feb;146:e122-e138. doi: 10.1016/j.wneu.2020.10.056. Epub 2020 Oct 17.
Comparative outcomes of extracranial-to-intracranial (EC-IC) and intracranial-to-intracranial (IC-IC) bypass for complex aneurysm treatment based on rupture status are not well described in the literature. In this study, we compare outcomes of EC-IC and IC-IC bypass for complex intracranial aneurysm treatment based on rupture status.
A prospective neurosurgical patient database was retrospectively reviewed. Sixty-three consecutive patients with aneurysm managed with revascularization were identified between July 2014 and December 2018.
During the study period, 41 patients with aneurysm underwent EC-IC bypass (65%; 24 [58.5%] ruptured, 17 [41.5%] unruptured) and 22 patients with aneurysm underwent IC-IC bypass (34.9%; 13 [59.1%] ruptured, 9 [40.9%] unruptured). Graft spasm occurred in 4 patients (9.8%) in the EC-IC group (all ruptured aneurysms) and all anastomoses were patent on immediate postoperative imaging. Perioperative mortality occurred in 5 patients who underwent EC-IC bypass (12.2%; 3 ruptured, 2 unruptured) EC-IC and 2 patients who underwent IC-IC bypass (9.1%; both ruptured); (P = 0.709). Bypass-related complications occurred only in patients with ruptured aneurysm (2 [8.3%] in the EC-IC group and 0 [0%] in the IC-IC group; P = 0.285). For unruptured aneurysms, the overall complication rate was lower in IC-IC compared with the EC-IC group (P = 0.006). Modified Rankin Scale scores on discharge were significantly lower in IC-IC compared with EC-IC bypass for unruptured aneurysms (P = 0.008). There was a trend for shorter temporary occlusion and hospitalization times and overall better outcomes with IC-IC compared with EC-IC bypass.
Although often considered riskier than EC-IC bypass, IC-IC in situ bypass showd a favorable technical and safety profile for the treatment of complex, unruptured aneurysms.
基于破裂状态，颅外-颅内（EC-IC）和颅内-颅内（IC-IC）旁路治疗复杂颅内动脉瘤的结果比较在文献中描述得并不充分。在这项研究中，我们根据破裂状态比较了 EC-IC 和 IC-IC 旁路治疗复杂颅内动脉瘤的结果。
回顾性分析了前瞻性神经外科患者数据库。2014 年 7 月至 2018 年 12 月，共确定了 63 例接受血管重建治疗的颅内动脉瘤患者。
研究期间，41 例颅内动脉瘤患者接受了 EC-IC 旁路治疗（65%；24 例[58.5%]破裂，17 例[41.5%]未破裂），22 例颅内动脉瘤患者接受了 IC-IC 旁路治疗（34.9%；13 例[59.1%]破裂，9 例[40.9%]未破裂）。EC-IC 组 4 例（9.8%）患者出现吻合口痉挛（均为破裂动脉瘤），所有吻合口在术后即刻影像学检查均通畅。行 EC-IC 旁路治疗的 5 例患者（12.2%；3 例破裂，2 例未破裂）和行 IC-IC 旁路治疗的 2 例患者（9.1%；均破裂）出现围手术期死亡（P=0.709）。仅在破裂动脉瘤患者中发生与旁路相关的并发症（EC-IC 组 2 例[8.3%]，IC-IC 组 0 例[0%]；P=0.285）。对于未破裂的动脉瘤，IC-IC 组的总体并发症发生率低于 EC-IC 组（P=0.006）。与 EC-IC 旁路相比，IC-IC 旁路治疗未破裂动脉瘤患者出院时改良 Rankin 量表评分显著降低（P=0.008）。IC-IC 旁路的临时闭塞时间和住院时间更短，整体预后更好。
尽管 IC-IC 旁路通常被认为比 EC-IC 旁路风险更大，但对于复杂未破裂动脉瘤的治疗，IC-IC 原位旁路显示出有利的技术和安全性。
