特集 安全・確実な手術方法―原 著
高流量バイパス術におけるバリエーション ─より安全，確実，シンプルな方法を目指して─
2019 年 47 巻 2 号 p. 103-108
詳細
2019 年 47 巻 2 号 p. 103-108
Extracranial-to-intracranial high-flow bypass (HFB) associated with intentional internal carotid artery occlusion has been mainly applied for complex intracranial aneurysms, including symptomatic cavernous sinus segment, blood blister-like, and large unclippable paraclinoid aneurysms. Although the surgical procedure of HFB has been established, some variations in the surgical procedure have been reported.
The purpose of the present study was to discuss the variations in the surgical procedure of HFB and their efficacy.
Twenty-five consecutive patients who underwent HFB between January 1, 2010 and March 31, 2017 were included in this study. The type and route of the graft vessel, creating an auxiliary bypass before the main graft anastomosis, and systemic heparinization were discussed as variations in the procedure.
The radial artery (RA) was used as a graft vessel in 21 patients, and the greater saphenous vein, in 4. The graft route was constructed from the proximal external carotid artery to the middle cerebral artery through the infratemporal fossa in all cases. In the upper cervical portion, a lower route between the hypoglossal nerve and posterior berry of the digastric muscle was chosen in 23 patients. In contrast, an upper route superior to the digastric muscle was used in 2 patients. Auxiliary bypass was used in only 2 patients who needed temporary occlusion of the dominant M2 during M2-RA anastomosis. Systemic heparinization was performed in all cases.
Postoperatively acute graft vessel occlusion was found in one case. Cerebral infarction after HFB was detected in 2 cases. Chronic graft vessel occlusion occurred in 1 patient, with no clinical symptom. No intracranial hemorrhagic complication accompanied by systemic heparinization was found.
HFB is an effective procedure to overcome complex intracranial aneurysms. Although the surgical procedure has been established, some variations are often adopted. Acquiring surgical skill in the procedural variations is essential for successful postoperative results.
