scholarly journals The evolution of cerebral revascularization surgery

2009 ◽  
Vol 26 (5) ◽  
pp. E17 ◽  
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.

scholarly journals Diagnosis and Management of Moyamoya Disease

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 137-142
Author(s):  
Shinichiro Uchiyama ◽  
Masako Yamazaki ◽  
Tatsuya Ishikawa ◽  
Koji Yamaguchi ◽  
Takakazu Kawamata
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Diagnosis And Management ◽  
The World ◽  
Children And Young Adults ◽  
Ischemic Attack ◽  
Revascularization Surgery

Moyamoya disease is an uncommon vascular disease, which causes obstruction and stenosis of arteries of the circle of Willis, and preferentially affects children and young adults. This disease is seen across the world, but is more common in East Asia. It may cause hemorrhagic or ischemic stroke, or transient ischemic attack. If symptoms or cerebral blood flow become worse, revascularization surgery is recommended. We present 2 cases of moyamoya disease who underwent bypass surgery. We also discuss the epidemiology, pathology, genomics, and symptomatology as well as diagnosis, and management of moyamoya disease.

Hypopituitarism following Coronary Artery Bypass Surgery

1997 ◽  
Vol 42 (4) ◽  
pp. 116-117 ◽  
Author(s):  
J.F.R. Cummings ◽  
R. Davies ◽  
R. W. Newton ◽  
C.J. Thompson
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Pituitary Apoplexy ◽  
Artery Bypass ◽  
Neurological Sequelae ◽  
Common Operation

Coronary artery bypass surgery (CABS) is a common operation,1 which is often complicated by neurological sequelae.2 Disturbances of cerebral blood flow have been reported up to eight days after surgery and pituitary apoplexy has previously been reported.3–5 We report a case of hypopituitarism without pituitary apoplexy, which developed after a period of sustained arterial hypotension, during coronary artery bypass surgery.

Significance of Quantitative Cerebral Blood Flow Measurement in the Acute Stage after Revascularization Surgery for Adult Moyamoya Disease: Implication for the Pathological Threshold of Local Cerebral Hyperperfusion

2019 ◽  
Vol 48 (3-6) ◽  
pp. 217-225 ◽  
Author(s):  
Masayuki Kameyama ◽  
Miki Fujimura ◽  
Ryosuke Tashiro ◽  
Kenichi Sato ◽  
Hidenori Endo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Intracerebral Hemorrhage ◽  
Perioperative Management ◽  
Pressure Control ◽  
Acute Stage ◽  
Cerebral Hyperperfusion ◽  
Auc Value ◽  
Revascularization Surgery

Objective: Superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis is a standard surgical procedure for adult patients with moyamoya disease (MMD) and plays a role in preventing ischemic and/or hemorrhagic stroke. Cerebral hyperperfusion (CHP) syndrome is a potential complication of this procedure that can result in deleterious outcomes, such as delayed intracerebral hemorrhage, but the exact threshold of the pathological increase in postoperative cerebral blood flow (CBF) is unclear. Thus, we analyzed local CBF in the acute stage after revascularization surgery for adult MMD to predict CHP syndrome under modern perioperative management. Materials and Methods: Fifty-nine consecutive adult MMD patients, aged 17–66 years old (mean 43.1), underwent STA-MCA anastomosis with indirect pial synangiosis for 65 affected hemispheres. All patients were perioperatively managed by strict blood pressure control (systolic pressure of 110–130 mm Hg) to prevent CHP syndrome. Local CBF at the site of anastomosis was quantitatively measured using the autoradiographic method by N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography 1 and 7 days after surgery, in addition to the preoperative CBF value at the corresponding area. We defined CHP phenomenon as a local CBF increase over 150% compared to the preoperative value. Then, we investigated the correlation between local hemodynamic change and the development of CHP syndrome. Results: After 65 surgeries, 5 patients developed CHP syndrome, including 2 patients with delayed intracerebral hemorrhage (3.0%), 1 with symptomatic subarachnoid hemorrhage (1.5%), and 2 with focal neurological deterioration without hemorrhage. The CBF increase ratio was significantly higher in patients with CHP syndrome (270.7%) than in patients without CHP syndrome (135.2%, p = 0.003). Based on receiver operating characteristic analysis, the cutoff value for the pathological postoperative CBF increase ratio was 184.5% for CHP syndrome (sensitivity = 83.3%, specificity =  94.2%, area under the curve [AUC] value  =  0.825) and 241.3% for hemorrhagic CHP syndrome (sensitivity =  75.0%, specificity =  97.2%, AUC value  =  0.742). Conclusion: Quantitative measurement of the local CBF value in the early postoperative period provides essential information to predict CHP syndrome after STA-MCA anastomosis in patients with adult MMD. The pathological threshold of hemorrhagic CHP syndrome was as high as 241.3% by the local CBF increase ratio, but 2 patients (3.0%) developed delayed intracerebral hemorrhage in this series that were managed following the intensive perioperative management protocol. Thus, we recommend routine CBF measurement in the acute stage after direct revascularization surgery for adult MMD and satisfactory blood pressure control to avoid the deleterious effects of CHP.

scholarly journals Comparative efficacy of autologous versus cadaveric saphenous vein grafts in cerebral revascularization surgery

2020 ◽  
pp. 1-7 ◽  
Author(s):  
Christopher J. Stapleton ◽  
Ahmed E. Hussein ◽  
Mandana Behbahani ◽  
Ali Alaraj ◽  
Sepideh Amin-Hanjani ◽  
...  
Keyword(s):  
Blood Flow ◽  
Saphenous Vein ◽  
Statistical Significance ◽  
Cerebral Revascularization ◽  
Flow Index ◽  
Vein Grafts ◽  
Saphenous Vein Grafts ◽  
Bypass Patency ◽  
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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