Extra- intracranial Arteri al Micro anastomosis

Czech version

Authors: D. Krahulík ¹; M. Vaverka ¹; R. Herzig ²; P. Hluštík ²; M. Ho udek ¹
Authors‘ workplace: Ne urochirurgická klinika LF UP a FN Olomo uc, 2Ne urologická klinika LF UP a FN Olomo uc ¹
Published in: Cesk Slov Neurol N 2009; 72/105(2): 142-146
Category: Original Article

Overview

Introducti on:
The a uthors present the gro up of pati ents indicated to extra- intracrani al bypass on the basis of evalu ati on of cerebrovascular re activity (CVR) by Transcrani al Doppler Sonography (TCD) and Functi onal Magnetic Resonance Imaging (fMRI).

Pati ents and methods:

Extra- intracrani al bypass was indicated for 35 pati ents over the last five ye ars.

Results:
During one ye ar follow‑up, CVR improved in 29 (82 %) pati ents. The patency of bypass was 92 % by TCD. CVR improvement was recorded in one pati ent after nine months. 30- day mortality was zero and 30- day morbidity was 2.9 %.

Conclusi on:
Both the non‑invasive methods of evalu ati on of CVR are safe, generally available and can be used for postoperative screening. Based on o ur experi ence, the use of the two methods can be recommended.

Key words:
extracrani al- intracrani al arteri al bypass – cerebrovascular re activity – transcrani al Doppler sonography – functi onal magnetic resonance imaging

Sources

1. Yamashita T, Kashiwagi S, Nakano S, Takasago T, Abiko S, Shiroyama Y et al. The effect of EC- IC bypass surgery on resting cerebral blo od flow and cerebrovascular reserve capacity studi ed with stable XE- CT and acetazolamide test. Ne uroradi ology 1991; 33(3): 217– 222.

2. Lythgoe DJ, Willi ams SC, Cullinane M, Markus HS. Mapping of cerebrovascular re activity using BOLD magnetic resonance imaging. Magn Reson Imaging 1999; 17(4): 495– 502.

3. Kleinschmidt A, Steinmetz H, Sitzer M, Merboldt KD, Frahm J. Magnetic resonance imaging of regi onal cerebral blo od oxygenati on changes under acetazolamide in carotid occlusive dise ase. Stroke 1995; 26(1): 106– 110.

4. Müller M, Voges M, Pi epgras U, Schimrigk K. Assessment of cerebral vasomotor re activity by transcrani al Doppler ultraso und and bre ath- holding. A comparison with acetazolamide as vasodilatory stimulus. Stroke 1995; 26(1): 96– 100.

5. Widder B. Use of bre ath holding for evalu ating cerebrovascular reserve capacity. Stroke 1992; 23(11): 1680– 1681.

6. Hlustik P, Solodkin A, Gullapalli RP, Noll DC, Small SL. Somatotopy in human primary motor and somatosensory hand representati ons revisited. Cereb Cortex 2001; 11(4): 312– 321.

7. Small SL, Hlustik P, Noll DC, Genovese C, Solodkin A. Cerebellar hemispheric activati on ipsilateral to the paretic hand correlates with functi onal recovery after stroke. Brain 2002; 125(7): 1544– 1557.

8. Herzig R, Hlustik P, Mares J, Burval S, Herman M, Kanovsky P. Cerebral vasore activy assessment in unilateral common carotidartery occlusi on with patency of external and internal carotidarteri es. An fMR study of the motor cortex. Cerebrovasc Dis 2006; 21 (Suppl 4): 67.

9. Carusone LM, Srinivasan J, Gitelman DR, Mesulam MM, Parrish TB. Hemodynamic response changes in cerebrovascular dise ase: implicati ons for functi onal MR imaging. Am J Ne uroradi ol 2002; 23(7): 1222– 1228.

10. Yaşargil MG. Microsurgery Appli ed To Ne urosurgery. Stuttgart: Ge org Thi eme Verlag 1969.

11. Yaşargil MG, Krayenbuhl HA, Jacobson JH jr. Microne urosurgical arteri al reconstructi on. Surgery 1970; 67(1): 221– 233.

12. Barnett HJ, Fox A, Hachinski V, Haynes B, Peerless SJ, Sackett D et al. Further conclusi ons from the extracrani al- intracrani al bypass tri al. Surg Ne urol 1986; 26(3): 227– 235.

13. Barnett HJ, Sackett D, Taylor DW, Haynes B, Peerless SJ, Meissner I et al. Are the results of the extracrani al- intracrani al bypass tri al generalizable? N Engl J Med 1987; 316(13): 820– 824.

14. Derdeyn CP, Yundt KD, Videen TO, Carpenter DA, Grubb RL jr, Powers WJ. Incre ased oxygen extracti on fracti on is associ ated with pri or ischemic events in pati ents with carotid occlusi on. Stroke 1998; 29(4): 754– 758.

15. Beneš V et al (eds). Ischémi e mozku. Praha: Galén 2003.

16. Kaku Y, Watarai H. Less invasive technique for EC- IC bypass. Acta Ne urochir Suppl 2008; 103: 83– 86.

17. Mehdorn HM. Cerebral revascularizati on by EC- IC bypass – present status. Acta Ne urochir Suppl 2008; 103: 73– 77.