Cerebral Revascularization for Ischemia, Aneurysms, and Cranial Base Tumors

Sekhar, Laligam N.; Natarajan, Sabareesh K.; Ellenbogen, Richard G.; Ghodke, Basavaraj

doi:10.1227/01.neu.0000333803.97703.c6

Cited by 120 publications

(102 citation statements)

References 86 publications

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“…30,31 Therefore, simple and accessible models for microvascular anastomosis training are increasingly essential for providing a means for refining and preserving skills. Several models, including chicken wings, 12,17 turkey wings, 1 rats, 15 human cadavers, 24,29 and plastic tubing, 22 have been proposed.…”

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confidence: 99%

Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study

Belykh

Lei

Safavi–Abbasi

et al. 2016

JNS

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N eurosurgical vascular cases often require complex microvascular bypass techniques, such as those used in operative corrections for moyamoya disease, 7,26,32 cerebral aneurysms, 9,13,14,19 and intracranial tumors. 30,31 Therefore, simple and accessible models for microvascular anastomosis training are increasingly essential for providing a means for refining and preserving skills. Several models, including chicken wings, 12,17 turkey wings, 1 rats, 15 human cadavers, 24,29 and plastic tubing, 22 have been proposed. However, these models are still less than ideal for various reasons, such as vessel diameter diversity, cost-effectiveness, artifacts due to storage (e.g., Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study obJective Microvascular anastomosis is a basic neurosurgical technique that should be mastered in the laboratory. Human and bovine placentas have been proposed as convenient surgical practice models; however, the histologic characteristics of these tissues have not been compared with human cerebral vessels, and the models have not been validated as simulation training models. In this study, the authors assessed the construct, face, and content validities of microvascular bypass simulation models that used human and bovine placental vessels. methods The characteristics of vessel segments from 30 human and 10 bovine placentas were assessed anatomically and histologically. Microvascular bypasses were performed on the placenta models according to a delineated training module by "trained" participants (10 practicing neurosurgeons and 7 residents with microsurgical experience) and "untrained" participants (10 medical students and 3 residents without experience). Anastomosis performance and impressions of the model were assessed using the Northwestern Objective Microanastomosis Assessment Tool (NOMAT) scale and a posttraining survey. results Human placental arteries were found to approximate the M 2 -M 4 cerebral and superficial temporal arteries, and bovine placental veins were found to approximate the internal carotid and radial arteries. The mean NOMAT performance score was 37.2 ± 7.0 in the untrained group versus 62.7 ± 6.1 in the trained group (p < 0.01; construct validity). A 50% probability of allocation to either group corresponded to 50 NOMAT points. In the posttraining survey, 16 of 17 of the trained participants (94%) scored the model's replication of real bypass surgery as high, and 16 of 17 (94%) scored the difficulty as "the same" (face validity). All participants, 30 of 30 (100%), answered positively to questions regarding the ability of the model to improve microsurgical technique (content validity). coNclusioNs Human placental arteries and bovine placental veins are convenient, anatomically relevant, and beneficial models for microneurosurgical training. Microanastomosis simulation using these models has high face, content, and construct validities. A NOMAT score of more than 5...

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confidence: 99%

Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study

Belykh

Lei

Safavi–Abbasi

et al. 2016

JNS

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“…[2][3][4]6,8,9) The present case involved an MCA (M 2 )-ACA (A 1 )-RA interposition graft bypass to secure blood flow into the ACA territory. The same bypass procedure was performed for the treatment of complex aneurysm.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12] In the majority of cases, procedures are performed using an extracranial artery as a donor artery with or without interposition graft (extracranial-intracranial bypass). 1,4,5,7,[9][10][11] We encountered a case in which intracranial-intracranial bypass appeared preferable, given the anatomical configuration and operative approach employed, which may support the concept that intracranial-intracranial bypass may represent an advanced form of vascular reconstruction that is effective in selected patients. 8) …”

Section: Introductionmentioning

confidence: 99%

Middle Cerebral-Anterior Cerebral-Radial Artery Interposition Graft Bypass for Proximal Anterior Cerebral Artery Aneurysm -Case Report-

Kazumata

Asaoka

Yokoyama

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 74-year-old man underwent pterional craniotomy to treat a left proximal anterior cerebral artery (ACA) aneurysm. The orifice of the aneurysm was located at the origin of the proximal segment of the ACA, and the right A 1 segment of ACA was hypoplastic. After failed attempts at neck plasty with fenestrated clips, trapping and bypass were performed. Superficial temporal to left frontopolar artery bypass was performed to secure minimal blood supply. The radial artery (RA) was then harvested, and middle cerebral artery (MCA) to A 1 segment of the ACA bypass was performed using the RA interposition graft. Trapping of the aneurysm was successfully achieved without ischemic event. Intracranial-intracranial bypass has been employed in the treatment of complex cerebral aneurysm in an increasing number of selected patients. The present case shows that MCA-ACA-RA interposition graft bypass is an effective procedure to provide blood supply to the ACA territory if a proximal A 1 lesion requires trapping with incompetent contralateral A 1 .

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“…17 The choice of bypass procedure depends on the amount of flow replacement required, and the size and availability of donor and recipient vessels. Immediate results and management of the bypass 13,23,27 and clinical follow-up results 13,22,24 have been reported previously. However, factors related to symptomatic watershed infarction (WI) have not been analyzed.…”

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confidence: 81%

Risk factors for neurological worsening and symptomatic watershed infarction in internal carotid artery aneurysm treated by extracranial-intracranial bypass using radial artery graft

Matsukawa

Tanikawa

Kamiyama

et al. 2016

JNS

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T he negative results of the Carotid Occlusion Surgery Study trial 21 and the introduction of flow-diverting stents 16 have resulted in many practitioners rethinking the utility of cerebral revascularization for vascular pathologies. However, revascularization techniques remain indispensable because of the need for complex reconstructions when endovascular therapies fail in patients with cerebral aneurysm. In addition, cerebral revascularization abbreviatioNs ECA = external carotid artery; EC-IC = extracranial-intracranial; ICA = internal carotid artery; IQR = interquartile range; MCA = middle cerebral artery; mRS = modified Rankin Scale; PCoA = posterior communicating artery; RA = radial artery; STA = superficial temporal artery; WI = watershed infarction. obJective The revascularization technique, including bypass created using the external carotid artery (ECA), radial artery (RA), and M 2 portion of middle cerebral artery (MCA), has remained indispensable for treatment of complex aneurysms. To date, it remains unknown whether diameters of the RA, superficial temporal artery (STA), and C 2 portion of the internal carotid artery (ICA) and intraoperative MCA blood pressure have influences on the outcome and the symptomatic watershed infarction (WI). The aim of the present study was to evaluate the factors for the symptomatic WI and neurological worsening in patients treated by ECA-RA-M 2 bypass for complex ICA aneurysm with therapeutic ICA occlusion. methods The authors measured the sizes of vessels (RA, C 2 , M 2 , and STA) and intraoperative MCA blood pressure (initial, after ICA occlusion, and after releasing the RA graft bypass) in 37 patients. Symptomatic WI was defined as presence of the following: postoperative new neurological deficits, WI on postoperative diffusion-weighted imaging, and ipsilateral cerebral blood flow reduction on SPECT. Neurological worsening was defined as the increase in 1 or more modified Rankin Scale scores. First, the authors performed receiver operating characteristic curve analysis for continuous variables and the binary end point of the symptomatic WI. The clinical, radiological, and physiological characteristics of patients with and without the symptomatic WI were compared using the log-rank test. Then, the authors compared the variables between patients with and without neurological worsening at discharge and at the 12-month follow-up examination or last hospital visit. results Symptomatic WI was observed in 2 (5.4%) patients. The mean MCA pressure after releasing the RA graft (< 55 mm Hg; p = 0.017), mean (MCA pressure after releasing the RA graft)/(initial MCA pressure) (< 0.70 mm Hg; p = 0.032), and mean cross-sectional area ratio ([RA/C 2 diameter] 2 < 0.40 mm [p < 0.0001] and [STA/C 2 diameter] 2 < 0.044 mm [p < 0.0001]) were related to the symptomatic WI. All preoperatively independent patients remained independent (modified Rankin Scale score < 3). After adjusting for age and sex, left operative side (p = 0.0090 and 0.038) and perforating artery ischemia (p = 0.0050 a...

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Cerebral Revascularization for Ischemia, Aneurysms, and Cranial Base Tumors

Cited by 120 publications

References 86 publications

Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study

Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study

Middle Cerebral-Anterior Cerebral-Radial Artery Interposition Graft Bypass for Proximal Anterior Cerebral Artery Aneurysm -Case Report-

Risk factors for neurological worsening and symptomatic watershed infarction in internal carotid artery aneurysm treated by extracranial-intracranial bypass using radial artery graft

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