ISSN:1077-2855    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1077-2855    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Abstract:Cerebral revascularization procedures are designed to enhance cerebral blood flow (CBF) to prevent or treat cerebral ischemia. Although the microsurgical techniques for cerebral revascularization are mature, the precise indications for surgery in many clinical scenarios are in an evolutionary stage. There remains considerable controversy, for example, regarding the indications for cerebral revascularization in patients with internal carotid artery occlusions or in those with planned carotid sacrifice for skull base tumors or aneurysms. The authors review the clinical scenarios in which revascularization would be considered and discuss current concepts regarding the indications for revascularization procedures.

ISSN:1077-2855    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Abstract:Superficial temporal artery to middle cerebral artery revascularization has evolved as a method to treat selected patients with intracranial ischemia. Specific indications include nonatherosclerotic occlusive vascular disorders, symptomatic brain ischemia in patients with inaccessible atherosclerotic occlusive disease who have not responded to maximal medical therapy, carotid artery dissection or penetrating injuries, and as an adjunct for deliberate large vessel arterial occlusion after failure of temporary trial occlusion. Careful preoperative evaluation and meticulous attention to detail before surgery yield good patient outcomes with minimal adverse effects and few deaths. This study reviews the indications and operative techniques for superficial temporal artery to middle cerebral artery anastomosis, the most common extracranial to intracranial revascularization procedure.

ISSN:1077-2855    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Abstract:Extracranial to intracranial bypass using an interposed saphenous vein has become a valuable cerebrovascular surgical procedure in the past 30 years. Most commonly, the vein is connected to the cervical carotid system proximally and the intracranial internal carotid or middle cerebral artery distally. Bypass procedures to augment the posterior circulation are also possible. These procedures have been used primarily to increase cerebral blood flow to an ischemic cerebral hemisphere and to prevent ischemic complications when a major vessel, such as the internal carotid or vertebral artery, must be sacrificed to treat a skull base tumor or unclippable aneurysm. Meticulous attention to the technique of vein harvest, tunneling, anastomosis, and restoration of flow will help ensure high patency and low complication rates. The history, indications, technique, complications, and results of interposition long vein grafts in extracranial to intracranial bypass operations is reviewed.

ISSN:1077-2855    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Abstract:Revascularization of the vertebrobasilar territory is indicated for the management of carefully selected patients with refractory vertebrobasilar insufficiency, and complex unclippable aneurysms of the posterior circulation. Successful results depend on careful patient selection, choice of the appropriate bypass procedure for each individual patient, meticulous surgical technique, and optimal pre and postoperative management. The following revascularization procedures are described: external carotid artery (ECA)-to-posterior cerebral artery (PCA) saphenous vein interposition graft; superficial temporal artery (STA)-to-superior cerebellar artery (SCA) bypass; occipital artery (OA)-to-anterior inferior cerebellar artery (AICA) bypass; OA-to-posterior inferior cerebellar artery (PICA) bypass; PICA-PICA anastomosis; and vertebral artery microendarterectomy.

ISSN:1077-2855    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Abstract:The utility of short vein grafts for revascularization has been demonstrated for occlusive cerebrovascular disease; cerebrovascular aneurysms; skull base tumors of the cavernous sinus, petrous carotid artery, and jugular foramen; iatrogenic injury to cervical and intracranial vasculature; and intracranial venous hypertension from jugular foramen stenosis. Despite the high level of technical expertise demonstrated by neurosurgeons performing these procedures, the rate of graft failure is still greater than 10%. Most vein bypass failures occur within the first 48 hours of surgery, and the entire graft usually must be revised to reestablish patency. Early failures are associated with significant neurologic morbidity and mortality while late failures tend to be asymptomatic. The literature demonstrates the successful application of saphenous vein interposition grafts in certain patients who require a high-flow conduit for the treatment of the aforementioned disease processes.

ISSN:1077-2855    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Abstract:The surgical experience with 865 intracranial aneurysms is presented. Aneurysms arose from internal carotid artery 358 (41%), anterior cerebral artery 215 (25%), middle cerebral artery 192 (22%), vertebrobasilar circulation 100 (12%); 109 (13%) were giant aneurysms. Complex cerebral artery aneurysms are defined as aneurysms equal to or larger than 20 mm. There were 151 complex aneurysms, measuring 20 to 84 mm in diameter, in patients 16 to 72 years old. Fifty patients had subarachnoid hemorrhage, all had chronic headaches, 30 had focal neurologic findings secondary to mass effect. Ninety-eight patients underwent direct clipping, 16 had the aneurysm trapped and an intracranial anastomosis performed in 11, and 26 others had an extracranial-intracranial anastomosis in addition to trapping. Five patients had a proximal occlusion with no additional surgery, and five had endovascular treatment. Temporary clamp times: 7 to 155 minutes. Forty-seven patients did not have temporary clipping. Immediate neurologic worsening was noted in 53 patients, of whom 40 recovered before discharge, and 13 remained permanent. Of 15 deaths, five subarachnoid hemorrhage (grade 4 and 5) in whom vasospasm developed immediately after operation. Long-term recovery of the survivors (12-80 months) was excellent; 104 patients were normal, 5 patients had a mild deficit but returned to full function, and 14 had a severe deficit. Two more patients died of unrelated causes. Immediate postoperative angiography revealed complete obliteration or exclusion of the aneurysm in every patient. All extracranial-intracranial anastomoses were patent, as were all intracranial reconstructions. Collateral flow was observed in the territories of the distal arteries, which were trapped and not bypassed. Five patients who died had severe arterial vasospasm distal to the aneurysm location. All surviving patients returned to independent living, although only 30 were able to return to work. No additional deaths in the long-term survivors were related to their aneurysms or surgery. Complex cerebral artery aneurysm may be handled successfully without resorting to extraordinary measures, such as cardiopulmonary arrest.

ISSN:1077-2855    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Abstract:Ischemic neurological symptoms are sometimes caused by stenotic or occlusive lesions of the major arterial trunks arising from the aortic arch. The indication for surgical repair of such lesions is the failure of medical treatment to prevent ischemic episodes. Cerebral blood flow studies can aid in selecting patients for surgical treatment. Direct repair by endarterectomy or grafting is the preferred method of treatment. Arterial origin stenosis can be treated by dividing the artery distal to the lesion and reimplanting it into a healthy artery. Bypass grafts used to treat these lesions include aorta to brachiocephalic trunk, aorta to subclavian artery, aorta to common or internal carotid artery, carotid to subclavian artery, subclavian or brachiocephalic to carotid artery, and carotid to vertebral artery. Excellent results can be achieved in carefully selected patients. Avoiding simultaneous procedures can minimize morbidity and mortality. Endovascular techniques are likely to play a greater role in the future.

ISSN:1077-2855    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Abstract:Indirect revascularization is an important surgical technique for the treatment of moyamoya disease. This technique can be applied to other forms of cerebral ischemia, though at present, it is used exclusively for revascularization in moyamoya disease. The donor material is vascular rich tissue that can potentially induce neovascularization of the ischemic brain, and as the donor site, the temporal muscle, other muscles, the dura mater, the middle cerebral artery, the superficial temporal and occipital arteries, and the omentum can be used. However, the success of this indirect revascularization is mostly dependent on the condition of the recipient (brain). Cytokines, including basic fibroblast growth factor, may play an important role in neovascularization. The authors relate their experience with indirect revascularization in patients with moyamoya disease and review this indirect revascularization method, focusing in detail on the surgical technique.

ISSN:1077-2855    

出版商:OVID    

年代:2000

数据来源: OVID