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CURRENT ISSUEJOURNAL OF NEUROSURGICAL SCIENCES

A Journal on Neurosurgery


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Journal of Neurosurgical Sciences 1999 December;43(4):237-51

 ORIGINAL ARTICLES

­Long saph­e­nous-­vein ­grafts ­for extra­cra­ni­al ­and intra­cra­ni­al inter­nal carot­id aneu­rysms amen­able nei­ther to clip­ping ­nor to endo­vas­cu­lar treat­ment

Santoro A. 1, Guidetti G. 2, Dazzi M. 2, Cantore G. 1

1 Dipar­ti­men­to di ­Scienze Neu­ro­lo­giche, Neu­ro­chi­rur­gia I, Università ­degli Stu­di “La Sapien­za”, ­Roma;
2 Ser­vi­zio Spe­ciale di Neu­ro­ra­dio­lo­gia, ­Università ­degli Stu­di “La Sapien­za”, ­Roma

Back­ground. In ­the treat­ment of ­patients ­with unclip­pable, uncoil­able inter­nal carot­id ­artery aneu­rysms it ­may be nec­es­sary to ­use ­high-­flow ­bypass ­grafts. ­The indi­ca­tions, sur­gi­cal tech­niques ­and com­pli­ca­tions ­are dis­cussed.
Meth­ods. Dur­ing a 12- year peri­od, 20 saph­e­nous ­vein ­grafts ­were per­formed in 20 ­patients. ­The 20 aneu­rysms ­were locat­ed in ­the prep­e­trous or intra­pe­trous inter­nal carot­id ­artery in 7 cas­es, ­the intra­ca­ver­nous in 9 ­and intra­cra­ni­al inter­nal carot­id ­artery in 4. ­All aneu­rysms ­were symp­to­mat­ic. ­The ­vein ­graft ­was inter­posed ­between ­the inter­nal carot­id ­artery at ­the ­neck ­and ­the intra­pe­trous carot­id, ­from ­the inter­nal carot­id ­artery at ­the ­neck to a ­branch of ­the mid­dle cere­bral ­artery, or ­from ­the exter­nal carot­id ­artery ­and a ­branch of ­the mid­dle cere­bral ­artery, accord­ing to ­the col­lat­er­al cir­cu­la­tion ­assessed ­with a 30-min­ute ­the bal­loon ­test occlu­sion dur­ing elec­tro­en­ce­phal­o­graph­ic record­ing.
­Results. ­Only ­one of ­the 20 ­grafts occlud­ed. ­One ­patient ­died ­from a ­large post­op­er­a­tive cere­bral infarc­tion. ­One ­patient ­had cere­bral ische­mia ­with tran­sient hemi­par­e­sis; ­and ­three ­patients ­had ­mixed apha­sia ­that ­resolved com­plete­ly with­in ­two ­weeks. Radio­log­i­cal fol­low-up mon­i­tor­ing ­was by mag­net­ic res­o­nance imag­ing, mag­net­ic res­o­nance angio­gra­phy or dig­i­tal angio­gra­phy. Post­op­er­a­tive fol­low-up ­ranged ­from 1 to 12 ­years (­mean 3.7 ­years).
Con­clu­sions. ­Our expe­ri­ence in ­this ­series sug­gests ­that ­the indi­ca­tions ­for cere­bral revas­cu­lar­iza­tion ­should be wid­ened, ­even to ­include ­patients ­with ade­quate col­lat­er­al cir­cu­la­tion, par­tic­u­lar­ly ­those ­who ­have a ­long ­life expec­tan­cy.

language: English


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