Predictors of the Resolution of Cavernous Sinus Syndrome Caused by Large/Giant Cavernous Carotid Aneurysms After Parent Artery Occlusion with High-Flow Bypass

OBJECTIVEBecause simple intracranial aneurysms (IAs) are increasingly treated endovascularly, neurovascular surgery has become focused on complex IAs that may require deconstructive aneurysm therapy with concomitant surgical bypass. The authors describe the decision-making process concerning cerebral revascularization and present outcomes that were achieved in a large case series of complex IAs managed with cerebral revascularization and parent artery occlusion.METHODSThe authors retrospectively reviewed the medical records, including neuroimaging studies, operative reports, and follow-up clinic notes, of all patients who were treated at the National Brain Aneurysm Center between July 1997 and June 2015 using cerebral revascularization as part of the management of an IA. They recorded the location, rupture status, and size of each IA, as well as neurological outcome using the modified Rankin Scale (mRS), aneurysm and bypass status at follow-up, and morbidity and mortality.RESULTSThe authors identified 126 patients who underwent revascularization surgery for 126 complex, atheromatous, calcified, or previously coiled aneurysms. Ninety-seven lesions (77.0%) were unruptured, and 99 (78.6%) were located in the anterior circulation. Aneurysm size was giant (≥ 25 mm) in 101 patients, large (10–24 mm) in 9, and small (≤ 9 mm) in 16 patients. Eighty-four low-flow bypasses were performed in 83 patients (65.9%). High-flow bypass was performed in 32 patients (25.4%). Eleven patients (8.7%) underwent in situ or intracranial-intracranial bypasses. Major morbidity (mRS score 4 or 5) occurred in 2 (2.4%) low-flow cases and 3 (9.1%) high-flow cases. Mortality occurred in 2 (2.4%) low-flow cases and 2 (6.1%) high-flow cases. At the 12-month follow-up, 83 (98.8%) low-flow and 30 (93.8%) high-flow bypasses were patent. Seventy-five patients (90.4%) undergoing low-flow and 28 (84.8%) high-flow bypasses had an mRS score ≤ 2. There were no statistically significant differences in patency rates or complications between low- and high-flow bypasses.CONCLUSIONSWhen treating challenging and complex IAs, incorporating revascularization strategies into the surgical repertoire may contribute to achieving favorable outcomes. In our series, low-flow bypass combined with isolated proximal or distal parent artery occlusion was associated with a low rate of ischemic complications while providing good long-term aneurysm control, potentially supporting its wider utilization in this setting. The authors suggest that consideration should be given to managing complex IAs at high-volume centers that offer a multidisciplinary team approach and the full spectrum of surgical and endovascular treatment options to optimize patient outcomes.

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Internal carotid artery occlusion may affect long-term quality of life in patients with high-flow carotid cavernous fistulas

Interventional Neuroradiology ◽

10.1177/1591019919864668 ◽

2019 ◽

Vol 26 (1) ◽

pp. 83-89 ◽

Cited By ~ 1

Author(s):

Rong-Qin Dai ◽

Wei-Xing Bai ◽

Bu-Lang Gao ◽

Tian-Xiao Li ◽

Kun Zhang

Keyword(s):

Quality Of Life ◽

Artery Occlusion ◽

High Flow ◽

Parent Artery ◽

Parent Artery Occlusion ◽

Carotid Cavernous Fistulas ◽

Headache Impact

Purpose To investigate the mid- and long-term effects of parent artery occlusion on the carotid cavernous fistula and on the quality of life of patients. Materials and methods One hundred and twenty-six patients with high-flow direct carotid cavernous fistulas were enrolled. The modified Rankin scale scores, the headache impact test and the short form health survey scores were used to evaluate the patients' clinical status. Results Fifty-two patients had parent artery occlusion, while the rest of the 74 patients had embolization of carotid cavernous fistulas with parent artery preservation. No periprocedural complications occurred. Eighteen patients in the parent artery occlusion group had low perfusion symptoms within two weeks following embolization, and three patients had Horner's syndrome on the ipsilateral side. At two months' follow-up, the patients with parent artery occlusion had a significantly ( P < 0.05) greater proportion of headache than patients with parent artery preservation. At 12 months, no significant ( P > 0.05) difference existed in the headache impact test scores in both groups. At 36 months' follow-up, the patients with parent artery occlusion had decreased SF-30 scores in all the eight health domains compared with patients treated with parent artery preservation, with a significant ( P < 0.05) lower score in general health, vitality and bodily pain in the parent artery occlusion compared with the parent artery preservation group. No recurrence was shown in patients with parent artery occlusion, but nine (12.2%) patients were recurrent in patients with parent artery preservation. Conclusion Parent artery occlusion may affect the quality of life of patients with carotid cavernous fistulas despite being an effective treatment option for high-flow direct fistulas.

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Revascularization and Parent Artery Occlusion for Giant Internal Carotid Artery Aneurysms in the Intracavernous Portion Using Intraoperative Monitoring of Cerebral Hemodynamics

Neurosurgery ◽

10.1227/01.neu.0000190656.21717.ae ◽

2006 ◽

Vol 58 (1) ◽

pp. 43-50 ◽

Cited By ~ 25

Author(s):

Yoshitaka Kubo ◽

Kuniaki Ogasawara ◽

Nobuhiko Tomitsuka ◽

Yasunari Otawara ◽

Shunsuke Kakino ◽

...

Keyword(s):

Carotid Artery ◽

Middle Cerebral Artery ◽

Artery Bypass ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Artery Occlusion ◽

High Flow ◽

Parent Artery ◽

Bypass Grafting ◽

Parent Artery Occlusion

Abstract OBJECTIVE: Therapeutic parent artery occlusion with or without revascularization is a useful surgical technique for the management of a giant aneurysm located in the intracavernous portion of the internal carotid artery (ICA). The purpose of the present study was to determine whether intraoperative cortical blood flow (CoBF) monitoring during surgical parent artery occlusion could identify patients who required bypass with a saphenous vein graft (high flow bypass). METHODS: Eleven patients with a giant aneurysm located in the intracavernous portion of the ICA underwent superficial temporal artery-middle cerebral artery bypass. CoBF was monitored intraoperatively in all patients using a thermal diffusion flow probe. The lowest CoBF during test occlusion of the ICA under functioning superficial temporal artery-middle cerebral artery bypass was determined, and the ratio of the value to the CoBF immediately before test occlusion of the ICA was calculated in the frontal and temporal lobes. When the CoBF ratio in the frontal or temporal lobe was less than 0.9, high flow bypass grafting was elected. RESULTS: Of the eleven patients undergoing superficial temporal artery-middle cerebral artery bypass, five patients underwent concomitant high flow bypass grafting. Postoperative cerebral ischemic events did not occur in any patient over a follow-up period ranging from 3 to 60 months. Postoperative cerebral angiography showed resolution of the aneurysm and patency of the bypass in all patients. CONCLUSION: Intraoperative CoBF monitoring using a thermal diffusion flow probe during surgical parent artery occlusion for giant intracavernous carotid artery aneurysms can identify patients who require concomitant high flow bypass grafting.

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A large paraclinoid aneurysm treated by preoperative ophthalmic artery embolization followed by high flow bypass and proximal parent artery occlusion: a case report

Journal of Neuroendovascular Therapy ◽

10.5797/jnet.7.11 ◽

2013 ◽

Vol 7 (1) ◽

pp. 11-17

Author(s):

Shigenori KATAYAMA ◽

Keiji KIDOGUCHI ◽

Naoya TAKEDA

Keyword(s):

Case Report ◽

Ophthalmic Artery ◽

Artery Occlusion ◽

High Flow ◽

Parent Artery ◽

Artery Embolization ◽

Paraclinoid Aneurysm ◽

Parent Artery Occlusion

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High Flow Bypass for Cavernous Carotid Aneurysms

Romanian Neurosurgery ◽

10.2478/romneu-2018-0032 ◽

2018 ◽

Vol 32 (2) ◽

pp. 262-271

Author(s):

Maruf Matmusaev ◽

Temur Duschanov ◽

Yasuhiro Yamada ◽

Katsumi Takizawa ◽

Tsukasa Kawase ◽

...

Keyword(s):

Radial Artery ◽

Doppler Sonography ◽

High Flow ◽

Low Flow ◽

Arterial Graft ◽

Parent Artery ◽

High Morbidity ◽

Proximal Internal Carotid Artery ◽

Carotid Aneurysms ◽

Cavernous Carotid Aneurysms

Abstract Introduction and objective: High flow extracranial to intracranial (HF EC-IC) cerebral revascularisation may be necessary in the management of complex skull base tumours and intracranial aneurysms. Bypass grafting can be considered high flow when a radial artery or the saphenous vein is interposed between the extracranial carotids arteries and intracranial vessels. The decision as to whether to use a low flow or high flow bypass is determined by the anticipated cerebral blood flow needed and the availability of a supply source. In this study, we have used this method to bypass for two cases of giant aneurysms of the cavernous sinus part of the ICA. Methods: Two cases of giant ICE aneurysm not amenable to clipping or coiling were taken since 2016. Patients were treated in Neurosurgery department of Fujita Health University Banbuntane Hotokukai Hospital, Nagoya, Japan. During bypass surgery, intraoperative methods were used to determine the patency of the graft artery: Doppler sonography and indocyanine green (ICG) Dual-Image Videoangiography (DIVA). Results: Two patients with symptomatic large and giant cavernous carotid aneurysms were evaluated as not amenable for clipping or endovascular treatment due to location and size of the aneurysm and associated high morbidity risk with these treatment options. In both cases radial artery graft was used for high-flow EC-MCA bypass and proximal internal carotid artery was ligated. Additionally, for high-flow bypass was performed superficial temporal artery (STA) to middle cerebral artery (MCA) bypass. DIVA, ICG and Doppler sonography were used multiple times to assess the patency of graft artery. In one case there was not complete ligation of the IC after postop DSA, the next day was performed reintervention to completely ligate IC. Postoperative course was uneventful, there were no mortality or morbidity. Follow-up showed good recovery and postoperative CT and DSA showed complete occlusion of ligated IC and patent functioning arterial graft. Conclusions: Cavernous carotid aneurysms (CCA) are rare and pose considerable challenges in management. A bypass procedure before parent artery occlusion, preferable to reduce the risks of postocclusion stroke. Intraoperative Doppler sonography and DIVA makes it easy to check the patency of the graft. DIVA is superior over Doppler or ICG in terms of better visualization of related anatomical structures.

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Treatment of giant/large internal carotid aneurysms: parent artery occlusion or stent-assisted coiling

International Journal of Neuroscience ◽

10.3109/00207454.2014.992427 ◽

2015 ◽

Vol 126 (1) ◽

pp. 46-52 ◽

Cited By ~ 5

Author(s):

Hui Li ◽

Xu-Ying He ◽

Xi-Feng Li ◽

Xin Zhang ◽

Yan-Chao Liu ◽

...

Keyword(s):

Internal Carotid ◽

Artery Occlusion ◽

Parent Artery ◽

Parent Artery Occlusion ◽

Carotid Aneurysms

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Peripheral intracranial aneurysms: management challenges in 60 consecutive cases

Journal of Neurosurgery ◽

10.3171/2008.6.jns0814 ◽

2009 ◽

Vol 110 (1) ◽

pp. 7-13 ◽

Cited By ~ 28

Author(s):

Eric S. Nussbaum ◽

Michael T. Madison ◽

James K. Goddard ◽

Jeffrey P. Lassig ◽

Leslie A. Nussbaum

Keyword(s):

Intracranial Aneurysms ◽

Artery Occlusion ◽

Neurological Deficits ◽

Parent Artery ◽

Branch Points ◽

Aneurysm Neck ◽

Vertebrobasilar System ◽

Parent Artery Occlusion ◽

Major Branch ◽

Proximal Occlusion

Object The authors report the management and outcomes of 55 patients with 60 intracranial aneurysms arising distal to the major branch points of the circle of Willis and vertebrobasilar system. Methods Between July 1997 and December 2006, the authors' neurovascular service treated 2021 intracranial aneurysms in 1850 patients. The database was reviewed retrospectively to identify peripherally located intracranial aneurysms. Aneurysms that were mycotic and aneurysms that were associated with either an arteriovenous malformation or an atrial myxoma were excluded from review. Results The authors encountered 60 peripheral intracranial aneurysms in 55 patients. There were 42 small, 7 large, and 11 giant lesions. Forty-one (68%) were unruptured, and 19 (32%) had bled. Fifty-three aneurysms were treated surgically by using direct clip reconstruction in 26, trapping or proximal occlusion with distal revascularization in 21, excision with end-to-end anastomosis in 3, and circumferential wrap/clip reconstruction in 3. Coils were used to treat 6 aneurysms, and 1 was treated by endovascular parent artery occlusion. Overall, 49 patients had good outcomes, 4 were left with new neurological deficits, and 2 died. Conclusions Peripherally situated intracranial aneurysms are rare lesions that present unique management challenges. Despite the fact that in the authors' experience these lesions were rarely treatable with simple clipping of the aneurysm neck or endovascular coil occlusion, preservation of the parent artery was possible in most cases, and the majority of patients had a good outcome.

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