Quantitative Stratification of Hemodynamic Cerebral Ischemia in Cerebral Revascularization Surgery.

OBJECTIVECerebral bypasses are performed for the purpose of either flow augmentation for ischemic cerebrovascular disease or flow replacement for vessel sacrifice during complex aneurysm or tumor surgery. Saphenous vein grafts (SVGs) are commonly used interposition grafts. The authors of this study sought to compare the efficacy of autologous versus cadaveric SVGs in a large series of cerebral bypasses using interposition vein grafts with long-term angiographic follow-up.METHODSAll intracranial bypass procedures performed between 2001 and 2018 were reviewed. Demographic, clinical, angiographic, and operative data were recorded and then analyzed according to SVG type.RESULTSA total of 308 consecutive intracranial bypasses were performed during the study period, 53 (17.2%) of which were bypasses with an interposition SVG (38 autologous, 15 cadaveric). At a median follow-up of 2.2 months (IQR 0.2–29.1), 39 (73.6%) bypasses were patent (26 [68.4%] autologous, 13 [86.7%] cadaveric, p = 0.30). Comparing autologous and cadaveric SVG recipients, there were no statistically significant differences in age (p = 0.50), sex (p > 0.99), history of smoking (p = 0.75), hypertension (p > 0.99), diabetes mellitus (p = 0.13), indication for bypass (p = 0.27), or SVG diameter (p = 0.65). While there were higher intraoperative (autologous, 100.0 ml/min, IQR 84.3–147.5; cadaveric, 80.0 ml/min, IQR 47.3–107.8; p = 0.11) and postoperative (autologous, 142.2 ml/min, IQR 76.8–160.8; cadaveric, 92.0 ml/min, IQR 69.2–132.2; p = 0.42) volumetric flow rates in the autologous SVGs compared to those in the cadaveric SVGs, the difference between the two groups did not reach statistical significance. In addition, the blood flow index, or ratio of postoperative to intraoperative blood flow, for each bypass was similar between the groups (autologous, 1.3, IQR 0.9–1.6; cadaveric, 1.5, IQR 1.0–2.3; p = 0.37). Kaplan-Meier estimates showed no difference in bypass patency rates over time between autologous and cadaveric SVGs (p = 0.58).CONCLUSIONSCadaveric SVGs are a reasonable interposition graft option in cerebral revascularization surgery when autologous grafts are not available.

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Specific clinical features and one-stage revascularization surgery for moyamoya disease with severe cerebral ischemia in the territory of posterior cerebral artery

Acta Neurochirurgica ◽

10.1007/s00701-020-04580-7 ◽

2020 ◽

Author(s):

Hisayasu Saito ◽

Daina Kashiwazaki ◽

Haruto Uchino ◽

Shusuke Yamamoto ◽

Kiyohiro Houkin ◽

...

Keyword(s):

Cerebral Ischemia ◽

Clinical Features ◽

Moyamoya Disease ◽

Cerebral Artery ◽

Posterior Cerebral Artery ◽

One Stage ◽

Revascularization Surgery

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Cerebral Revascularization Surgery: Surgical Indications and Strategies

Contemporary Neurosurgery ◽

10.1097/01.cne.0000767096.59507.83 ◽

2021 ◽

Vol 43 (2) ◽

pp. 6-6

Keyword(s):

Cerebral Revascularization ◽

Surgical Indications ◽

Revascularization Surgery

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An experimental study on laser-induced suturing of venous grafts in cerebral revascularization surgery

10.1117/12.586720 ◽

2005 ◽

Author(s):

Alfredo Puca ◽

Alessio Albanese ◽

Giuseppe Esposito ◽

Giulio Maira ◽

Giacomo Rossi ◽

...

Keyword(s):

Experimental Study ◽

Cerebral Revascularization ◽

Venous Grafts ◽

Revascularization Surgery

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The evolution of cerebral revascularization surgery

Neurosurgical FOCUS ◽

10.3171/2009.3.focus0931 ◽

2009 ◽

Vol 26 (5) ◽

pp. E17 ◽

Cited By ~ 10

Author(s):

Melanie G. Hayden ◽

Marco Lee ◽

Raphael Guzman ◽

Gary K. Steinberg

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

20Th Century ◽

Nobel Prize ◽

Bypass Surgery ◽

Cerebral Revascularization ◽

Cerebral Bypass ◽

Revascularization Surgery ◽

French Surgeon

Among the relatively few surgeons to be awarded the Nobel Prize was Alexis Carrel, a French surgeon and pioneer in revascularization surgery at the turn of the 20th century. The authors trace the humble beginnings of cerebral revascularization surgery through to the major developments that helped shape the modern practice of cerebral bypass surgery. They discuss the cornerstone studies in the development of this technique, including the Extracranial/Intracranial Bypass Study initiated in 1977. Recent innovations, including modern techniques to monitor cerebral blood flow, microanastomosis techniques, and ongoing trials that play an important role in the evolution of this field are also evaluated.

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Treatment of moyamoya disease in the adult population with pial synangiosis

Journal of Neurosurgery ◽

10.3171/2013.11.jns131027 ◽

2014 ◽

Vol 120 (3) ◽

pp. 612-617 ◽

Cited By ~ 10

Author(s):

Ning Lin ◽

Joshua P. Aronson ◽

Sunil Manjila ◽

Edward R. Smith ◽

R. Michael Scott

Keyword(s):

Moyamoya Disease ◽

Adult Population ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Adult Patients ◽

Cerebral Revascularization ◽

Age At Surgery ◽

Indirect Revascularization ◽

Revascularization Surgery

Object Surgical treatment of moyamoya disease in the adult population commonly uses direct revascularization, the superficial temporal artery (STA) to middle cerebral artery (MCA) bypass (STA-MCA). Pial synangiosis, a method of indirect revascularization, has been used in adult patients with moyamoya when STA-MCA bypass was not technically feasible. Although the effectiveness of pial synangiosis has been well described in children, only limited reports have examined its role in adult patients with moyamoya disease. In this study the authors report on their experience with pial synangiosis revascularization for this population. Methods The authors reviewed the clinical and radiographic records of all adult patients (≥ 18 years of age) with moyamoya disease who underwent cerebral revascularization surgery using pial synangiosis at a single institution. Results From 1985 to 2010, 66 procedures (6 unilateral, 30 bilateral) were performed on 36 adult patients with moyamoya disease. The mean age at surgery was 28.3 years, and 30 patients were female. Twenty-eight patients (77.8%) presented with transient ischemic attacks (TIAs), 24 (66.7%) with stroke, and 3 (8.3%) with hemorrhage. Preoperative Suzuki stage was III or higher in 50 hemispheres (75.8%) and 3 patients had undergone prior treatments to the affected hemisphere before pial synangiosis surgery. Clinical follow-up was available for an average of 5.8 years (range 0.6–14.1 years), with 26 patients (72.2%) followed for longer than 2 years. Postoperative angiography was available for 24 patients and 46 revascularized hemispheres, and 39 (84.8%) of the 46 hemispheres demonstrated good collateral formation (Matsushima Grade A or B). Postoperative complications included 3 strokes, 5 TIAs, and 2 seizures, and there was no hemorrhage during the follow-up period. One patient required additional revascularization surgery 8 months after pial synangiosis. Conclusions Pial synangiosis is a safe and durable method of cerebral revascularization in adult patients with moyamoya and can be considered as a potential treatment option for moyamoya disease in adults.

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