Abstract:
OBJECTIVE:Direct surgery for complex internal carotid artery (ICA) aneurysms can be difficult. In certain situations, sacrificing the parent artery is a unique way to obliterate the aneurysm and extracranial-to-intracranial (EC-IC) bypass is indispensable to prevent postoperative cerebral ischemia. This article discusses the indications for direct ICA occlusion, and the strategies, techniques, and outcomes in a series of patients treated for complex ICA aneurysms in a single institution. METHODS:During a 7-year period, 49 patients with complex ICA aneurysms underwent direct ICA sacrifice, or ICA sacrifice combined with EC-IC bypass. The appropriate type of bypass was determined by the results of balloon occlusion test and computed tomographic perfusion. The technique of ICA sacrifice used was selected based on the evaluation of retrograde filling of the aneurysm during balloon occlusion test. RESULTS:Ten patients underwent direct ICA sacrifice and no ischemia-related complications were evident during the 5-12 months of follow-up. A total of 39 patients were treated by ICA sacrifice combined with EC-IC bypass, including 21 cases of superficial temporal artery-radial artery-middle cerebral artery and 18 cases of external carotid artery-radial artery-middle cerebral artery. ICA sacrifice was achieved in 38 patients by using prolonged occlusion (25 cases) or acute occlusion (13 cases). Five patients presented with minor ischemia after surgery, but four patients recovered completely. Two patients developed brain swelling postoperatively and one developed intracranial hemorrhage, which required evacuation of the hematoma. CONCLUSION:Balloon occlusion test combined with computed tomographic perfusion can be an efficient way to evaluate the compromised cerebrovascular reserve in patients with complex ICA aneurysms after ICA occlusion. In conjunction with EC-IC bypass, ICA proximal occlusion or trapping can be an effective treatment strategy.
journal_name
World Neurosurgjournal_title
World neurosurgeryauthors
Zhu W,Tian YL,Zhou LF,Song DL,Xu B,Mao Ydoi
10.1016/j.wneu.2010.07.043subject
Has Abstractpub_date
2011-03-01 00:00:00pages
476-84issue
3-4eissn
1878-8750issn
1878-8769pii
S1878-8750(10)00767-9journal_volume
75pub_type
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journal_title:World neurosurgery
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journal_title:World neurosurgery
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pub_type: 杂志文章
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pub_type: 杂志文章
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journal_title:World neurosurgery
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更新日期:2020-11-01 00:00:00
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journal_title:World neurosurgery
pub_type: 传,历史文章,杂志文章,评审
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更新日期:2015-11-01 00:00:00
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journal_title:World neurosurgery
pub_type: 杂志文章
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更新日期:2021-01-01 00:00:00
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journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.10.082
更新日期:2017-02-01 00:00:00
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pub_type: 杂志文章,随机对照试验
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更新日期:2020-06-01 00:00:00
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journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.09.116
更新日期:2017-01-01 00:00:00
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journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.10.141
更新日期:2018-04-01 00:00:00
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journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.02.084
更新日期:2019-06-01 00:00:00
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pub_type: 杂志文章
doi:10.1016/j.wneu.2016.07.079
更新日期:2016-11-01 00:00:00
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pub_type: 杂志文章
doi:10.1016/j.wneu.2017.07.095
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pub_type: 传,历史文章,杂志文章,评审
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journal_title:World neurosurgery
pub_type: 杂志文章
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更新日期:2019-12-01 00:00:00
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pub_type: 杂志文章
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更新日期:2019-02-01 00:00:00
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pub_type: 杂志文章
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更新日期:2020-01-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2018-11-01 00:00:00