Korean J Cerebrovasc Surg.  2004 Sep;6(2):109-113.

Complications of Extracranial-Intracranial Bypass Surgery

Affiliations
  • 1Catholic Neuroscience Center, Department of Neurosurgery, St. Mary's Hospital Catholic University, Seoul, Korea. hkrha@catholic.ac.kr

Abstract


OBJECTIVES
Extracranial-intracranial (EC-IC)bypass procedures have proved useful in selected patients with cerebral ischemia. We have experienced EC-IC bypass procedures in 85 patients with hemodynamic cerebral ischemia, moya moya and complicated aneurysm. In this study, complications after EC-IC bypass procedures was investigated.
METHODS
Authors performed EC-IC bypass surgery for augmentation of cerebral blood flow in 85 patients for recent 7 years. Of 85 patients, the pathologic lesions were artherosclerotic hemodynamic cerebral ischemia in 60, moya moya in 14, complicated aneurysm in 9, and traumatic occlusion of the carotid artery in 2. An superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis was performed in 67 cases and graft bypass with saphenous vein or radial artery in 18 cases.
RESULTS
Of 85 patients who underwent bypass surgery, 63 had an uneventful postoperative course. Fifteen patients had hyperperfusion syndrome that included temporary neurologic deficit in 7, reperfusion hemorrhage in 3, seizure in 3, and neusea and vomiting in 2. Five patients had wound problems. Permanant neurologic deficit and complete obstruction of the preoperative stenotic lesion occured in one respectively. All patients except three cases of reperfusion hemorrhage and one case of permanent neurologic deficit recovered completely. Two of three cases of reperfusion hemorrhage and one case of permanent neurologic deficit recovered with minor neurologic deficit, and the remaining one case of reperfusion hemorrhage died.
CONCLUSION
EC-IC bypass surgery is a reliable and reasonably safe method for establishing new pathways of collateral circulation to the brain. However, this operation can have potential complications by relative hyperperfusion of chronically hypoperfused and presumably dysautoregulated region, and new flow pattern after bypass. Bypass is deferred to 8 weeks till impaired autoregulation is restored after acute cerebral infarction. And blood pressure should be controlled closely throughout the immediate postoperative period.

Keyword

EC-IC bypass; Hemodynamic cerebral ischemia; Moya moya; Complications

MeSH Terms

Aneurysm
Blood Pressure
Brain
Brain Ischemia
Carotid Arteries
Cerebral Arteries
Cerebral Infarction
Collateral Circulation
Hemodynamics
Hemorrhage
Homeostasis
Humans
Neurologic Manifestations
Postoperative Period
Radial Artery
Reperfusion
Saphenous Vein
Seizures
Transplants
Vomiting
Wounds and Injuries
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