Ishiguro Taichi, Yamaguchi Koji, Ishikawa Tatsuya, Ottomo Daiki, Funatsu Takayuki, Matsuoka Go, Omura Yoshihiro, Kawamata Takakazu
Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
J Neurosurg Case Lessons. 2021 Nov 1;2(18):CASE21439. doi: 10.3171/CASE21439.
Trapping an aneurysm after the establishment of an extracranial to intracranial high-flow bypass is considered the optimal surgical strategy for ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA). For high-flow bypass surgeries, a radial artery graft is generally preferred over a saphenous vein graft (SVG). However, SVGs can be advantageous in acute-phase surgeries because of their greater length, easy manipulability, ability to act as high-flow conduits, and reduced risk of vasospasms. In this study, the authors presented five cases of ruptured BBAs treated with high-flow bypass using an SVG followed by BBA trapping, and they reported on surgical outcomes and operative nuances that may help avoid potential pitfalls.
After the surgeries, there were no ischemic or hemorrhagic complications, including symptomatic vasospasms. In three of the five cases, postoperative modified Rankin scale scores were between 0 and 2 at the 3-month follow-up. In one case, the SVG spontaneously occluded after surgery while the protective superficial temporal artery (STA) to middle cerebral artery (MCA) bypass became dominant, and the patient experienced no ischemic symptoms.
High-flow bypass using an SVG with a protective STA-MCA bypass followed by BBA trapping is a safe and effective treatment strategy.
在建立颅外至颅内高流量旁路后夹闭动脉瘤被认为是治疗颈内动脉（ICA）破裂血泡样动脉瘤（BBAs）的最佳手术策略。对于高流量旁路手术，桡动脉移植物通常比大隐静脉移植物（SVG）更受青睐。然而，由于SVG长度更长、易于操作、能够作为高流量管道以及血管痉挛风险降低，在急性期手术中SVG可能具有优势。在本研究中，作者介绍了5例采用SVG进行高流量旁路手术并随后夹闭BBA的破裂BBAs病例，并报告了手术结果和手术细节，这些可能有助于避免潜在的陷阱。
手术后，未出现缺血性或出血性并发症，包括有症状的血管痉挛。在5例中的3例中，3个月随访时改良Rankin量表评分在0至2之间。1例患者术后SVG自发闭塞，而起到保护作用的颞浅动脉（STA）至大脑中动脉（MCA）旁路占主导地位，患者未出现缺血症状。
采用SVG进行高流量旁路手术并联合保护型STA-MCA旁路，随后夹闭BBA是一种安全有效的治疗策略。
