Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin Medical University, Tianjin, China.
Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China.
Oper Neurosurg (Hagerstown). 2023 Mar 1;24(3):301-309. doi: 10.1227/ons.0000000000000510. Epub 2022 Dec 9.
Basilar trunk aneurysms are the most surgically challenging, and the spectrum covers small fusiform to dolichoectatic aneurysms and may lead to rupture, brain ischemia, or direct brainstem compression. The current strategy remains cerebral revascularization coupled with aneurysm trapping. Available bypass options for upper posterior circulation (UPC) are based on (1) different flow volumes from diverse blood supplies and (2) distinct modulation purposes for cerebral revascularization; however, the potential compromise of eloquent perforators of the basilar trunk and the occurrence of fatal brainstem infarcts remain unacceptable.
To innovate a high-flow intracranial-intracranial skull base bypass for posterior circulation to afford robust retrograde flow and shorten the graft length.
We retrospectively reviewed our experience in the treatment of a patient with basilar trunk aneurysm and reported a novel bypass alternative supplied by petrous internal carotid artery to augment blood flow to the UPC by a pretemporal approach.
The postoperative course was uneventful, and there was no pons or midbrain ischemia or other complications. Postoperative computed tomography angiogram revealed the patency of bypass. There was no further development or rerupture observed during follow-up.
Petrous internal carotid artery as a donor site is a reliable bypass modality for UPC. This approach provides the utmost retrograde flow to alleviate the development of dissecting aneurysms, preserves eloquent perforators of the basilar trunk, maintains bypass patency, and shortens the graft course. Therefore, this novel therapeutic alternative could be beneficial for improving the prognosis of basilar trunk aneurysms.
基底动脉干动脉瘤是最具挑战性的手术，其范围包括小的梭形到梭形扩张动脉瘤，可能导致破裂、脑缺血或直接脑干压迫。目前的策略仍然是脑血运重建加动脉瘤夹闭。用于上后循环（UPC）的可用旁路选择基于 (1) 来自不同血液供应的不同流量，以及 (2) 脑血运重建的不同调节目的；然而，基底动脉干的功能区穿支动脉潜在的损害和致命性脑干梗死的发生仍然是不可接受的。
创新一种高流量颅内外颅底旁路，用于后循环，提供强大的逆行血流并缩短移植物长度。
我们回顾性地回顾了我们治疗基底动脉干动脉瘤患者的经验，并报告了一种新的旁路选择，通过颞前入路从岩骨内颈动脉供应血流以增加 UPC 的血流量。
术后过程平稳，没有出现脑桥或中脑缺血或其他并发症。术后 CT 血管造影显示旁路通畅。在随访期间没有进一步发展或再破裂。
岩骨内颈动脉作为供体部位是 UPC 的可靠旁路方式。这种方法提供最大程度的逆行血流，缓解夹层动脉瘤的发展，保留基底动脉干的功能区穿支动脉，保持旁路通畅，并缩短移植物行程。因此，这种新的治疗选择可能有利于改善基底动脉干动脉瘤的预后。
