Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
Oper Neurosurg (Hagerstown). 2023 Jul 1;25(1):41-51. doi: 10.1227/ons.0000000000000685. Epub 2023 May 10.
Very little research has been conducted to assess the efficacy of combined double-barrel superficial temporal artery (STA) to M4 bypass and parent artery occlusion (PAO) in the treatment of complex intracranial aneurysms.
To determine whether this operation could become a reasonable flow replacement therapy and have longer-term benefits.
A series of double-barrel STA-M4 bypasses performed between 2016 and 2021 were reviewed. Preoperative digital subtraction angiography (DSA), computed tomography angiography (CTA), computed tomography perfusion (CTP), and balloon test occlusion were routinely performed for a thorough evaluation of individual benefits and risks. After bypass, the proximal end of the parent artery was permanently occluded with the coil. Augmentation and patency of STA were reassessed by postoperative DSA, CTA, and CTP. The blood flow volume of STA was measured by ultrasound at admission and a 3-month follow-up.
This study included 12 consecutive patients (5 males, 7 females) who successfully underwent double-barrel STA-M4 bypass, including 8 complex aneurysms in the internal carotid artery (ICA) and 4 in the middle cerebral artery (MCA). Postoperative angiography and CTP suggested that all the STAs were patent, and there was a significant improvement in perfusion after the operation ( P < .05). Ultrasonic measurement at the 3-month follow-up showed that the blood flow provided by STA was 76.3 to 190.5 mL/min. Postoperative ischemia was found in 1 patient, but she recovered after treatment.
Double-barrel STA to M4 bypass can provide adequate flow for the parent artery area, which may be a reasonable flow replacement therapy for some complex intracranial aneurysms in ICA and MCA.
很少有研究评估联合双浅动脉（STA）至 M4 旁路和母动脉闭塞（PAO）治疗复杂颅内动脉瘤的疗效。
确定该手术是否可以成为一种合理的血流替代治疗方法，并具有更长期的益处。
回顾了 2016 年至 2021 年期间进行的一系列双 STA-M4 旁路手术。常规进行术前数字减影血管造影（DSA）、计算机断层血管造影（CTA）、计算机断层灌注（CTP）和球囊试验闭塞，以全面评估个体的获益和风险。旁路后，用线圈永久性闭塞母动脉近端。术后通过 DSA、CTA 和 CTP 重新评估 STA 的增强和通畅性。通过入院和 3 个月随访时的超声测量 STA 的血流体积。
本研究纳入了 12 例连续患者（5 例男性，7 例女性），成功进行了双 STA-M4 旁路手术，其中 8 例复杂颈内动脉（ICA）动脉瘤和 4 例大脑中动脉（MCA）动脉瘤。术后血管造影和 CTP 提示所有 STA 均通畅，术后灌注明显改善（P<0.05）。3 个月随访时的超声测量显示，STA 提供的血流为 76.3 至 190.5mL/min。1 例患者术后出现缺血，但经治疗后恢复。
双 STA 至 M4 旁路可以为母动脉区域提供足够的血流，这可能是治疗 ICA 和 MCA 某些复杂颅内动脉瘤的一种合理的血流替代治疗方法。
