Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Clin Neurol Neurosurg. 2023 Dec;235:108019. doi: 10.1016/j.clineuro.2023.108019. Epub 2023 Oct 24.
Flow-preservation bypass is a treatment option for complex intracranial aneurysms (IAs) that cannot be managed with microsurgical clipping or endovascular treatment. Various bypass methods are available, including interposition grafts such as the radial artery or saphenous vein. Size discrepancy, invasiveness, and procedure complexity must be considered when using interposition grafts. We describe our experience of treating complex IAs using a superficial temporal artery (STA) interposition bypass.
We retrospectively reviewed the medical records and operative videos of all patients who were treated for complex IAs at our center from January 2009 to December 2021 using cerebral revascularization. Clinical, radiological, and surgical findings of the cases that underwent STA interposition bypass were investigated.
Seventy-six bypass procedures were performed of which seven (9.2%) complex IAs were managed using STA interposition bypass. Of these 5 cases were of anterior cerebral artery, 1 of middle cerebral artery, and 1 of posterior inferior cerebellar artery aneurysm. There were no postoperative ischemic complications. Revision surgery for postoperative pseudomeningocele was performed in one case. The long-term bypass patency rate was 85.7% (6 out of 7) and good long-term aneurysm control was achieved in all cases, with a mean follow-up of 64 months.
When treating complex IAs, creative revascularization strategies are needed in selective cases for favorable outcomes. STA interposition graft bypass which can reduce the size discrepancy between the donor and recipient may be a less invasive, flexible, and practical option for treating complex IAs.
血流保护旁路是治疗无法通过显微夹闭或血管内治疗处理的复杂颅内动脉瘤（IA）的一种治疗选择。有多种旁路方法可供选择，包括桡动脉或隐静脉等中间移植物。在使用中间移植物时，必须考虑大小差异、侵袭性和手术复杂性。我们描述了使用颞浅动脉（STA）间置旁路治疗复杂 IA 的经验。
我们回顾性分析了 2009 年 1 月至 2021 年 12 月期间在我中心接受脑血管重建治疗的所有复杂 IA 患者的病历和手术录像。研究了接受 STA 间置旁路的病例的临床、影像学和手术发现。
共进行了 76 例旁路手术，其中 7 例（9.2%）复杂 IA 采用 STA 间置旁路治疗。其中 5 例为大脑前动脉动脉瘤，1 例为大脑中动脉动脉瘤，1 例为小脑后下动脉动脉瘤。术后无缺血性并发症。1 例术后假性脑膜膨出行翻修手术。长期旁路通畅率为 85.7%（7 例中有 6 例），所有病例均获得良好的长期动脉瘤控制，平均随访 64 个月。
在治疗复杂 IA 时，需要在选择病例中采用创造性的血运重建策略以获得良好的结果。STA 间置旁路移植可以减少供体和受体之间的大小差异，可能是治疗复杂 IA 的一种侵袭性更小、更灵活、更实用的选择。
