Double-insurance Bypass for Internal Carotid Artery Aneurysm Surgery
Double-insurance Bypass for Internal Carotid Artery Aneurysm Surgery
复制标题
颈内动脉瘤手术双保险搭桥
DOI：
10.1227/01.neu.0000047892.12003.58
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发表时间：
2003
期刊：
影响因子：
4.8
通讯作者：
Shigeaki Kobayashi
中科院分区：
文献类型：
--
作者：
K. Hongo;T. Horiuchi;J. Nitta;Yuichiro Tanaka;T. Tada;Shigeaki Kobayashi
本文的目的是介绍双旁路术在复杂颈内动脉（伊卡）动脉瘤手术治疗中的有效性。对于可夹闭但复杂的伊卡动脉瘤且侧支循环不良的患者，在暂时闭塞伊卡之前需要进行旁路手术。为了安全起见，我们建议采用双旁路。方法将颞浅动脉与大脑中动脉（MCA）远端皮质分支吻合，再将桡动脉与MCA下干吻合。对于可夹闭伊卡动脉瘤的患者，在采集桡动脉后，通过将同侧前臂抬高至头部，将桡动脉暂时闭合至MCA的下干。在动脉瘤被夹闭后，闭合的桡动脉在闭合部位附近被切断，并重新定位回到原来的手臂上。在两名患者中进行了双旁路手术，没有观察到与血运重建相关的缺血性并发症。颞浅动脉-MCA吻合术和桡动脉-MCA吻合术的MCA暂时闭塞时间分别为30和46分钟（1例患者）和28和55分钟（另1例患者）。结论：我们称之为“双保险旁路”的手术方法可以降低伊卡血运重建相关的缺血性并发症的风险。
OBJECTIVEThe aim of this article is to present the usefulness of a double-bypass method in the surgical treatment of complex internal carotid artery (ICA) aneurysms. For patients with clippable but complex aneurysms of the ICA having poor collateral circulation, bypass surgery is needed before temporary occlusion of the ICA. We propose a double bypass for safety. METHODSThe superficial temporal artery was anastomosed to the distal cortical branch of the middle cerebral artery (MCA), followed by anastomosis between the radial artery and the inferior trunk of the MCA. For patients with clippable ICA aneurysms, the radial artery was temporarily anastomosed to the inferior trunk of the MCA by raising the ipsilateral forearm to the head after the radial artery was harvested. After the aneurysm had been clipped, the anastomosed radial artery was cut close to the anastomosed site and repositioned back to the original arm. RESULTSThis double-bypass procedure was performed in two patients, and no ischemic complications related to revascularization were observed. Temporary occlusion times of the MCA for superficial temporal artery-to-MCA anastomosis and radial artery-to-MCA anastomosis were 30 and 46 minutes in one patient and 28 and 55 minutes in another. CONCLUSIONThis surgical procedure, which we called “double-insurance bypass,” can reduce the risk of ischemic complications associated with revascularization of the ICA.