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Revascularization for Complex Cerebral Aneurysms

Published online by Cambridge University Press:  18 February 2016

Bai-Nan Xu ,
Zheng-Hui Sun ,
Chen Wu ,
Jin-Li Jiang ,
Ding-Biao Zhou ,
Xin-Guang Yu ,
Garnette R. Sutherland  and
Bao-Min Li
Bai-Nan Xu*
Affiliation:
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China
Zheng-Hui Sun
Affiliation:
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China
Chen Wu
Affiliation:
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China
Jin-Li Jiang
Affiliation:
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China
Ding-Biao Zhou
Affiliation:
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China
Xin-Guang Yu
Affiliation:
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China
Garnette R. Sutherland
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
Bao-Min Li
Affiliation:
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China
*
Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, 28 Fuxing Rd, Haidian District, 100853, Beijing, Canada
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Abstract:

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Background and Purpose:

Complex cerebral aneurysms may require indirect treatment with revascularization. This manuscript describes various surgical revascularization techniques together with clinical outcomes.

Methods:

Thirty-two consecutive patients with complex cerebral aneurysm were managed from November 2005 to October 2008. Techniques used for revascularization were high-flow bypass, low-flow bypass, branch artery reimplantion, and primary reanastomosis. Physiologic and anatomic monitoring technologies, including electroencephalography, somatosensory evoked potential monitoring, microvascular doppler ultrasonography, and/or indocyanine green videoangiography were used intraoperatively to assess both brain physiology and vascular anatomy. Patient outcome was determined using the Glasgow Outcome Scale at discharge and at a mean of 12 months post operation (range 6-25 months).

Results:

Two cervical carotid aneurysms (6%) were resected followed by primary reanastomosis, 21 aneurysms (66%) were trapped following saphenous vein high-flow bypasses, five (16%) were clipped after superficial temporal or occipital artery low-flow bypasses, and four (12%) middle cerebral branch arteries were reimplanted. Of the 32 patients at discharge, 29 (91%) had a Glasgow Outcome Scale of four or five, two (6%) had severe disability, and one (3%) died.

Conclusion:

Cerebral revascularization remains an effective and reliable procedure for treatment of complex cerebral aneurysms. Low morbidity and mortality rates reflect the maturity of patient selection and surgical technique in the management of these lesions.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 5 , September 2011 , pp. 712 - 718
Copyright
Copyright © Canadian Neurological Sciences Federation 2011

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