Bypass Surgery for Complex Internal Carotid Artery Aneurysms : 39 Consecutive Patients

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Nurminen , V , Kivipelto , L , Kivisaari , R , Niemelä , M & Lehecka , M 2019 , ' Bypass Surgery for Complex Internal Carotid Artery Aneurysms : 39 Consecutive Patients ' , World Neurosurgery , vol. 126 , pp. E453-E462 .

Title: Bypass Surgery for Complex Internal Carotid Artery Aneurysms : 39 Consecutive Patients
Author: Nurminen, Ville; Kivipelto, Leena; Kivisaari, Riku; Niemelä, Mika; Lehecka, Martin
Contributor organization: HUS Neurocenter
Neurokirurgian yksikkö
Department of Neurosciences
Date: 2019-06
Language: eng
Number of pages: 10
Belongs to series: World Neurosurgery
ISSN: 1878-8750
Abstract: OBJECTIVE: Bypass surgery is a special technique used to treat complex internal carotid artery (ICA) aneurysms. The aim of this retrospective study is to provide a comprehensive description of treatment and outcome of complex ICA aneurysms at different ICA segments (cavernous, supraclinoid, ICA bifurcation) treated with bypass procedures. METHODS: We identified 39 consecutive patients with 41 complex ICA aneurysms that were treated with 44 bypass procedures between 1998 and 2016. We divided the aneurysms into 3 anatomic subgroups to review our treatment strategy. All the imaging studies and medical records were reviewed for relevant information. RESULTS: The aneurysm occlusion (n = 34, 83%) or flow modification (n = 5, 12%) was achieved in 39 aneurysms (95%). The long-term bypass patency rate was 68% (n = 30). Minor postoperative ischemia or hemorrhage was commonly seen (n = 20, 51%), but large-scale strokes were rare (n = 1, 3%). Preoperative dysfunction of extraocular muscles (cranial nerves III, IV, and VI) showed low-to-moderate improvement rates (20%-50%). Preoperative vision disturbance (cranial nerve II) improved seldom (22%). At the latest follow-up (mean; 51 months) 29 patients (74%) were independent (modified Rankin Scale CONCLUSIONS: Bypass surgery for complex ICA aneurysms is a feasible treatment method with an acceptable risk profile. Patients should be informed of the uncertainty related to improvement of pretreatment cranial nerve dysfunctions.
Subject: Bypass
Complex aneurysm
Cranial nerve dysfunction
Intracranial aneurysm
3112 Neurosciences
3124 Neurology and psychiatry
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: cc_by_nc_nd
Usage restriction: openAccess
Self-archived version: acceptedVersion

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