Department of Neurosurgery, Lille University Hospital, Hopital Nord, rue E. Laine, 59037 Lille cedex, France; University Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, 59000 Lille, France.
Department of Neurosurgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
Neurochirurgie. 2021 Apr;67(2):125-131. doi: 10.1016/j.neuchi.2020.10.001. Epub 2020 Oct 25.
The patency of cranial bypasses must be carefully evaluated during and after the microsurgical procedure. Although, several imaging techniques are used to evaluate the patency of bypasses, their findings are sometimes difficult to interpret.
The goal of this study was to assess the consistency of different diagnostic modalities for evaluating intracranial bypass patency.
This prospective study included 19 consecutive patients treated with EC-IC or IC-IC bypass for MoyaMoya disease (MMD) or complex/giant aneurysms between June 2016 and June 2018. In the early postoperative period (<7 days), all patients had transcranial Doppler (TCD), CT angiography (CTA) and MRA to demonstrate patency of anastomoses and to confirm exclusion of the aneurysm. When findings of anastomosis patency differed between these techniques, conventional angiography was performed.
All anastomoses were patent on indocyanine green videoangiography at the end of microsurgical procedure. The results of noninvasive postoperative exams were consistent to demonstrate the patency of anastomoses in 13 patients. In 4 patients, a discrepancy in patency of anastomoses arose between TCD, CTA and MRI in the early postoperative period. In 2 other patients, the interpretation of bypass patency remained inconclusive before the decision to occlude the aneurysm. In these 6 patients, a significant edema was noted in 2 cases, a postoperative subdural hematoma in 1 case, a low flow in the anastomosis in 1 case and vasospasm in 2 cases. The anastomosis was patent on the conventional angiography in five patients.
Noninvasive imaging techniques provide useful data about the patency but their findings should be carefully interpreted due to local anatomical, physiological, and pathological factors. In case of discrepant findings, conventional angiography including supraselective catheterization of the donor vessel is suggested.
在显微外科手术过程中和手术后，必须仔细评估颅旁路的通畅性。尽管有几种成像技术用于评估旁路的通畅性，但它们的结果有时难以解释。
本研究的目的是评估不同诊断方法评估颅内旁路通畅性的一致性。
这项前瞻性研究纳入了 19 例连续接受颈内-大脑中动脉（EC-IC）或大脑中动脉-大脑中动脉（IC-IC）旁路手术治疗烟雾病（MMD）或复杂/巨大动脉瘤的患者，手术时间为 2016 年 6 月至 2018 年 6 月。在术后早期（<7 天），所有患者均接受经颅多普勒（TCD）、CT 血管造影（CTA）和 MRA 检查，以显示吻合口通畅，并确认排除动脉瘤。当这些技术之间的吻合口通畅性发现存在差异时，进行常规血管造影。
所有吻合口在显微外科手术结束时的吲哚菁绿视频血管造影中均显示通畅。非侵入性术后检查的结果一致，13 例患者的吻合口通畅。在 4 例患者中，TCD、CTA 和 MRI 在术后早期吻合口通畅性存在差异。在另外 2 例患者中，在决定闭塞动脉瘤之前，旁路通畅性的解释仍不确定。在这 6 例患者中，2 例患者出现明显水肿，1 例患者出现术后硬膜下血肿，1 例患者吻合口血流低，2 例患者出现血管痉挛。5 例患者的常规血管造影显示吻合口通畅。
非侵入性成像技术提供了有关通畅性的有用数据，但由于局部解剖学、生理学和病理学因素，其结果应仔细解释。在存在不一致发现的情况下，建议进行包括供体血管超选择性导管插入术的常规血管造影。
