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

Neurosurgery ◽  
2006 ◽  
Vol 58 (1) ◽  
pp. 43-50 ◽  
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.

scholarly journals Combined Surgical and Endovascular Management of a Giant Fusiform PCA Aneurysm in a Pediatric Patient

2013 ◽  
Vol 19 (2) ◽  
pp. 222-227 ◽  
Author(s):  
S.H. Shin ◽  
I.S. Choi ◽  
K. Thomas ◽  
C.A. David
Keyword(s):  
Pediatric Patient ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Giant Aneurysm ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Endovascular Management ◽  
Excellent Outcome ◽  
Parent Artery Occlusion

Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The patient had an excellent outcome at one-year follow-up. Our case suggests a combined approach of surgical and endovascular management may yield a better outcome than surgery or endovascular management alone in the treatment of pediatric giant aneurysm.

Internal Carotid Artery Occlusion for Cavernous Segment Aneurysm

Neurosurgery ◽  
1989 ◽  
Vol 25 (3) ◽  
pp. 398-404 ◽  
Author(s):  
John R. Little ◽  
Jeffrey V. Rosenfeld ◽  
Issam A. Awad
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Brain Ischemia ◽  
Internal Carotid ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Flow Monitoring

Abstract We review our recent experience with occlusion of the cervical internal carotid artery (ICA) in 15 patients with symptomatic aneurysms of the cavernous segment. All the patients were women and ranged in age from 38 to 74 years. Ten patients sought treatment initially for ophthalmoplegia, 9 for retro-orbital pain, 8 for facial paresthesia, and 3 for loss of vision. Two patients had symptoms of transient ocular or brain ischemia. The diameter of the aneurysm was greater than 3 cm in 10 patients. Ten patients underwent gradual occlusion of the ICA by Selverstone clamp under anticoagulation and monitoring of neurological status. One patient underwent ligation of a severely stenotic ICA under general anesthesia and electroencephalographic monitoring. Four patients underwent trapping of the aneurysm (after attempts at direct obliteration) under electroencephalographic and cerebral blood flow monitoring. Two patients with incompetent circle of Willis collaterals underwent prophylactic superficial temporal artery to middle cerebral artery bypass surgery prior to ICA occlusion. There was no postoperative clinical change in 9 patients. Ophthalmoplegia improved in 2 patients, and facial pain improved in 3. Three patients developed new extraocular muscle palsies within hours of ICA occlusion; these resolved in all patients by 1 week postoperatively. No change in aneurysm size was documented by serial postoperative computed tomographic or magnetic resonance imaging scans. After a follow-up of 5 to 6 years (range, 6 months-9 years), 11 patients have remained neurologically stable. Two patients experienced delayed transient worsening of visual or facial symptoms. Two patients developed delayed ipsilateral brain ischemia: one patient had a visibly patent superficial temporal artery to middle cerebral artery bypass; the second patient had an occluded A-1 segment that previously had been patent. These results are discussed in light of direct approaches and recent techniques of intervention.

Optic chiasm compression from mass effect and thrombus formation following unsuccessful treatment of a giant supraclinoid ICA aneurysm with the Pipeline device: open surgical bailout with STA-MCA bypass and parent vessel occlusion

2014 ◽  
Vol 14 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Adib A. Abla ◽  
Hasan A. Zaidi ◽  
R. Webster Crowley ◽  
Gavin W. Britz ◽  
Cameron G. McDougall ◽  
...  
Keyword(s):  
Thrombus Formation ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Mass Effect ◽  
Parent Artery ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Unsuccessful Treatment ◽  
Parent Artery Occlusion

Pipeline Embolization Devices (PEDs) have been shown to be effective for intracranial internal carotid artery (ICA) aneurysms, and are now approved by the FDA specifically for this use. Potential pitfalls, however, have not yet been described in the pediatric neurosurgical literature. The authors report on a 10-year-old boy who presented to the Barrow Neurological Institute after progressive visual decline. He had undergone placement of a total of 7 telescoping PEDs at another facility for a large ICA aneurysm. Residual filling of the aneurysm and significant expansion of intraaneurysmal thrombus with chiasmal compression on admission images were causes for concern. The patient underwent a surgical bailout with a superficial temporal artery–middle cerebral artery bypass, with parent artery occlusion. Postoperative vascular imaging was notable for successful occlusion of the parent vessel, with no evidence of filling of the aneurysm. Reports on the pitfalls of PEDs in the neurosurgical literature are scarce. To the authors' knowledge this represents the first paper describing a successful open surgical bailout for residual aneurysmal filling and expansion of thrombus after placement of a PED.

Superficial Temporal Artery-to-Middle Cerebral Artery Bypass Grafting for Cerebral Revascularization

Neurosurgery ◽  
2004 ◽  
Vol 55 (2) ◽  
pp. 395-399 ◽  
Author(s):  
John E. Wanebo ◽  
Joseph M. Zabramski ◽  
Robert F. Spetzler
Keyword(s):  
Brain Tumors ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Bypass Grafting ◽  
Extensive Experience ◽  
Artery Bypass Grafting ◽  
Complex Aneurysms

Abstract SUPERFICIAL TEMPORAL ARTERY-to-middle cerebral artery bypass procedures are an important tool in the armamentarium of cerebrovascular surgeons for the treatment of carotid occlusion and revascularization for complex aneurysms and brain tumors. This article enumerates the essential steps in performing superficial temporal artery-to-middle cerebral artery bypass procedures. The nuances of this technique reflect the extensive experience of the senior authors (RFS, JMZ).

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