Revascularization and aneurysm surgery: Techniques, indications, and outcomes in the endovascular era

M. Yashar S. Kalani, Wyatt Ramey, Felipe C. Albuquerque, Cameron G. McDougall, Peter Nakaji, Joseph M. Zabramski, Robert F. Spetzler

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Given advances in endovascular technique, the indications for revascularization in aneurysm surgery have declined. OBJECTIVE: We sought to define indications, outline technical strategies, and evaluate the outcomes of patients treated with bypass in the endovascular era. METHODS: We retrospectively reviewed all aneurysms treated between September 2006 and February 2013. RESULTS: We identified 54 consecutive patients (16 males and 39 females) with 56 aneurysms. Aneurysms were located along the cervical internal carotid artery (ICA) (n = 1), petrous/cavernous ICA (n = 1), cavernous ICA (n = 16), supraclinoid ICA (n = 7), posterior communicating artery (n = 2), anterior cerebral artery (n = 4), middle cerebral artery (MCA) (n = 13), posterior cerebral artery (PCA) (n = 3), posterior inferior cerebellar artery (n = 4), and vertebrobasilar arteries (n = 5). Revascularization was performed with superficial temporal artery (STA) to MCA bypass (n = 25), STA to superior cerebellar artery (SCA) (n = 3), STA to PCA (n = 1), STA-SCA/STA-PCA (n = 1), occipital artery (OA) to PCA (n = 2), external carotid artery/ICA to MCA (n = 15), OA to MCA (n = 1), OA to posterior inferior cerebellar artery (n = 1), and in situ bypasses (n = 8). At a mean clinical follow-up of 18.5 months, 45 patients (81.8%) had a good outcome (Glasgow Outcome Scale 4 or 5). There were 7 cases of mortality (12.7%) and an additional 9 cases of morbidity (15.8%). At a mean angiographic follow-up of 17.8 months, 14 bypasses were occluded. Excluding the 7 cases of mortality, the majority of aneurysms (n = 42) were obliterated. We identified 7 cases of residual aneurysm and recurrence in 6 patients at follow-up. CONCLUSION: Given current limitations with existing treatments, cerebral revascularization remains an essential technique for aneurysm surgery.

Original languageEnglish (US)
Pages (from-to)482-497
Number of pages16
JournalNeurosurgery
Volume74
Issue number5
DOIs
StatePublished - May 2014
Externally publishedYes

Keywords

  • Aneurysm
  • Bypass
  • Cerebral revascularization
  • Clipping
  • Endovascular
  • Extracranial-to-intracranial
  • Intracranial-to-intracrania

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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  • Cite this

    S. Kalani, M. Y., Ramey, W., Albuquerque, F. C., McDougall, C. G., Nakaji, P., Zabramski, J. M., & Spetzler, R. F. (2014). Revascularization and aneurysm surgery: Techniques, indications, and outcomes in the endovascular era. Neurosurgery, 74(5), 482-497. https://doi.org/10.1227/NEU.0000000000000312