The application of intracranial-intracranial bypass for the treatment of complex basilar artery aneurysms

doi:10.3969/j.issn.1672-6731.2024.08.005

Abstract

Abstract:

Objective: To explore the surgical procedures and indications of intracranial-intracranial bypass for the treatment of complex aneurysms in the basilar artery (BA). Methods and Results: A retrospective analysis was conducted on the clinical data and treatment process of 6 patients with complex BA aneurysms who underwent intracranial-intracranial bypass from April 2017 to April 2023 in Tianjin Huanhu Hospital. Among the 6 aneurysms, 3 were vertebro basilar dolichoectasia aneurysms, one was an aneurysm in the upper segment of BA combined with severe stenosis at the proximal of the aneurysm, and 2 were giant dissecting aneurysms of the BA. Among them, 5 were ruptured aneurysms, with one case of Hunt-Hess grade Ⅴ, one case of grade Ⅳ, 2 cases of grade Ⅲ, and one case of grade Ⅱ, while the remaining one case was an unruptured aneurysm. One patient underwent petrous segment of internal carotid artery (ICA)-radial artery (RA)-posterior cerebral artery (PCA) bypass combined with aneurysm clipping, 4 patients underwent V3 segment of vertebral artery (VA)-RA-PCA bypass combined with aneurysm trapping, and one patient underwent middle cerebral artery (MCA)-RA-PCA bypass combined with aneurysm trapping. Four patients had good prognosis, with modified Rankin Scale (mRS) 0 to 3, one case scored 4 and one case died one week after surgery. Conclusions: For complex aneurysms of the BA that cannot be treated with conventional methods, intracranial-intracranial bypass provides a good option. It is necessary to select the appropriate surgical procedure based on the actual situation in clinical practice.

Key words: Intracranial aneurysm, Basilar artery, Cerebral revascularization

摘要：

目的: 探讨颅内-颅内血管搭桥术治疗基底动脉复杂动脉瘤的术式和适应证。方法与结果: 回顾2017年4月至2023年4月在天津市环湖医院行颅内-颅内血管搭桥术的6例基底动脉复杂动脉瘤患者的临床资料，3例为椎基底动脉延长扩张型动脉瘤，1例为基底动脉上段动脉瘤合并近端基底动脉重度狭窄，2例为基底动脉巨大型夹层动脉瘤；5例为破裂动脉瘤，Hunt-Hess分级Ⅴ级1例、Ⅳ级1例、Ⅲ级2例、Ⅱ级1例；1例为未破裂动脉瘤。6例患者均采用颅内-颅内血管搭桥术，主要包括颈内动脉岩骨段-桡动脉-大脑后动脉搭桥术联合动脉瘤夹闭术（1例）、椎动脉V3段-桡动脉-大脑后动脉搭桥术联合动脉瘤孤立术（4例）、大脑中动脉M2段-桡动脉-大脑后动脉P2段搭桥术联合动脉瘤孤立术（1例），均顺利完成手术。术后即刻复查影像学提示桥血管通畅，动脉瘤不显影，基底动脉上段显影良好。4例预后较好，改良Rankin量表（mRS）评分为0~3分；1例术前即为重症蛛网膜下腔出血（Hunt-Hess分级Ⅳ级），虽手术顺利，动脉瘤得以控制，但预后欠佳（mRS评分4分）；1例基底动脉干巨大型动脉瘤患者，术前存在蛛网膜下腔出血（Hunt-Hess分级Ⅴ级），虽手术顺利重建后循环并处理动脉瘤，仍于术后1周死亡。结论: 对于无法使用常规手段治疗的基底动脉复杂动脉瘤，颅内-颅内血管搭桥术能够为其提供较好的选择，临床根据实际情况选择合适术式。

关键词: 颅内动脉瘤, 基底动脉, 脑血管重建术

Kai-ming GAO, Xiao-guang TONG. The application of intracranial-intracranial bypass for the treatment of complex basilar artery aneurysms[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(8): 619-624.

高恺明, 佟小光. 颅内-颅内血管搭桥术在基底动脉复杂动脉瘤中的应用[J]. 中国现代神经疾病杂志, 2024, 24(8): 619-624.

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URL: https://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2024.08.005

https://journal11.magtechjournal.com/cjcnn/EN/Y2024/V24/I8/619

Figures/Tables 2

Figure 1 A 63-year-old male patient was admitted to the hospital (August 28, 2017) due to sudden onset of headache accompanied by nausea and vomiting for 6 h. CT confirmed the diagnosis of SAH (Hunt-Hess grade Ⅲ). DSA indicated the presence of an aneurysm at the upper segment of the BA, accompanied by severe stenosis proximal to the aneurysm. Consequently, a petrous segment of ICA-RA-P2 bypass combined with aneurysm clipping was performed. The preoperative and postoperative imaging findings and introperative findings Axial CT at admission showed high density in the sylvian fissure cistern and ambient cistern, suggesting SAH (Hunt-Hess grade Ⅲ, Panel 1a). Preoperative DSA showed the presence of an aneurysm at the upper segment of BA with severe stenosis proximal to the aneurysm (Panel 1b). A petrous segment of ICA-RA anastomosis was finished (Panel 1c). RA-P2 anastomosis was finished (Panel 1d). Whole view of the petrous segment of ICA-RA-P2 bypass (Panel 1e). Postoperative CTA 3D volume reconstruction showed that the aneurysm was not visualized, and the patency of the bypass (Panel 1f).

Figure 2 A 52-year-old male was admitted to the hospital (April 25, 2017) due to dysphagia accompanied by intermittent limb weakness for 2 months. He had a history of SAH 13 years ago. DSA showed a giant dissecting aneurysm of the BA. Consequently, a bypass surgery involving the V3 segment of the VA to the P2 segment of the PCA via the RA, combined with occlusion of the parent artery origin, was performed. The preoperative and postoperative imaging findings Preoperative axial CT shows a huge isodensity in the posterior cranial fossa, suggesting a huge BA aneurysm (Panel 2a). Preoperative axial T₂WI showed a giant dissecting aneurysm of the BA with thrombosis, causing compression on the brainstem (Panel 2b). Preoperative DSA 3D volume reconstruction showed the presence of a giant dissecting aneurysm of the BA (arrow indicates, Panel 2c). One week postoperatively, DSA 3D volume reconstruction showed the bypass vessel was patent, the parent artery was occluded, and the aneurysm was barely visible (Panel 2d).

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