Peroperative Evaluation of Extracranial-intracranial Bypass with Ultrasonographic Methods

Česká verzia

Authors: J. Fiedler ^1,2; V. Přibáň ^1,2; M. Bombic ¹
Authors place of work: Neurochirurgické oddělení, Nemocnice České Budějovice, a. s. ¹; Neurochirurgická klinika LF MU a FN Brno ²
Published in the journal: Cesk Slov Neurol N 2011; 74/107(1): 62-66
Category: Short Communication

Summary

Purpose:
The goal of this study was to evaluate low-flow extracranial-intracranial bypass patency using microvascular Doppler ultrasonography and to measure bypass blood flow values using transit time flow measurement, approaches that may lead to actual changes in operative strategy.

Methods:
We performed 10 low-flow extracranial-intracranial bypass surgical operations between August 2008 and March 2010. Diagnosis of exhausted cerebrovascular reserve capacity was established by transcranial Doppler ultrasonography and challenge perfusion CT. We employed standard operational technique for low-flow bypass.

Results:
There was no 30-day neurological morbidity and mortality and only one asymptomatic bypass occlusion event. Using transit time flow measurement led to a change of operative strategy in three cases.

Conclusion:
Peroperative monitoring by microvascular Doppler ultrasonography and transit time flow measurement is a simple and reproducible technique. It can reveal acute adverse changes in bypass blood flow that might result from technical error and allow the surgeon to take corrective measures immediately.

Key words:
cerebral revascularization – brain ischemia – Doppler ultrasonography – cerebrovascular circulation

Zdroje

1. Yaşargil MG, Krayenbuhl HA, Jacobson JH jr. Microneurosurgical arterial reconstruction. Surgery 1970; 67(1): 221–233.

2. Yaşargil MG, Yonekawa Y. Results of microsurgical extracranial-intracranial arterial bypass in the treatment of cerebral ischemia. Neurosurgery 1977; 1(1): 22–24.

3. Schmiedek P, Piepgras A, Leinsinger G, Kirsch CM, Einhaupl K. Improvement of cerebrovascular reserve capacity by EC-IC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia. J Neurosurg 1994; 81(2): 236–244.

4. Ausman JI, Chou SN, Lee M, Klassen A. Occipital to cerebellar artery anastomosis for brainstem infarction from vertebral basilar occlusive disease. Stroke 1976; 7: 13.

5. Amine AR, Moody RA, Meeks W. Bilateral temporal-middle cerebral artery anastomosis for Moyamoya syndrome. Surg Neurol 1977; 8(1): 3–6.

6. Garrett MC, Komotar RJ, Starke RM, Merkow MB, Otten ML, Sciacca RR et al. The efficacy of direct extracranial-intracranial bypass in the treatment of symptomatic hemodynamic failure secondary to athero-occlusive disease: a systematic review. Clin Neurol Neurosurg 2009; 111(4): 319–326.

7. Sundt TM jr, Whisnant JP, Fode NC, Piepgras DG, Houser OW. Results, complications, and follow-up of 415 bypass operations for occlusive disease of the carotid system. Mayo Clin Proc 1985; 60(4): 230–240.

8. Chater NL. Neurosurgical extracranial-intracranial bypass for stroke: with 400 cases. Neurol Res 1983; 5(2): 1–9.

9. Mendelowitsch A, Taussky P, Rem JA, Gratzl O. Clinical outcome of standard extracranial-intracranial bypass surgery in patients with symptomatic atherosclerotic occlusion of the internal carotid artery. Acta Neurochir 2004; 146(2): 95–101.

10. The EC/IC Bypass Study Group. Failure of extracranial-intracranial arterial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 1985; 313(19): 1191–1200.

11. Badie B, Lee FT Jr, Pozniak MA, Strother CM. Intraoperative sonographic assessment of graft patency during extracranial-intracranial bypass. AJNR Am J Neuroradiol 2000; 21(8): 1457–1459.

12. Kramár F, Benes V, Mohapl M. Doppler scanning in aneurysm surgery. Rozhl V Chir 2001; 80(1): 9–11.

13. Amin-Hanjani S, Charbel FT. Flow-assisted surgical technique in cerebrovascular surgery. Surg Neurol 2007; 68 (Suppl 1): S4–S11.

14. Aaslid R, Eden A, Ringelstein EB et al. Transcranial Doppler sonography. Wien: Springer-Verlag 1986.

15. Markus HS, Harrison MJG. Estimation of cerebrovascular reactivity using transcranial Doppler, including the use of breath-holding as the vasodilatory stimulus. Stroke 1992; 23(5): 668–673.

16. Bishop CFR, Powell S, Insall M, Rutt D, Browse NL. The effect of internal carotid artery occlusion on middle cerebral artery blood flow at rest and response to hypercapnia. Lancet 1986; 1: 710–712.

17. Kleiser B, Scholl D, Widder B. Assessment of cerebrovascular reactivity by Doppler CO2 and Diamox testing: which is the appropriate method? Cerebrovasc Dis 1994; 4: 134–138.

18. Widder B, Kornhuber HH. Extra-intracranial bypass surgery in carotid artery occlusions: who benefits? Neurol Psychiat Brain Res, 1994; 2: 126–131.

19. Hoeffner EG, Case I, Jain R, Gujar SK, Shah GV, Deveikis JP et al. Cerebral perfusion CT: Technique and clinical applications. Radiology 2004; 231(3): 632–644.

20. Vajkoczy P, Horn P, Schmiedek P. Standard STA-MCA bypass surgery in hemodynamic cerebral ischemia: indication and technique. Oper Tech Neurosurg 1999; 3(2): 106–115.

21. Arbeille P, Bouin-Pineau MH, Herault S. Accuracy of the main Doppler methods for evaluating the degree of carotid stenoses (continuous wave, pulsed wave, and color Doppler). Ultrasound Med Biol 1999; 25(1): 65–73.

22. Stendel R, Pietilä T, Al Hassan AA, Schilling A, Brock M. Intraoperative microvascular Doppler ultrasonography in cerebral aneurysm surgery. J Neurol Neurosurg Psychiatry 2000; 68(1): 29–35.

23. Drost CJ. Vessel diameter-independent volume flow measurements using ultrasound. Proc San Diego Biomed Symp 1978; 17: 299–302.

24. Lundell A, Bergqvist D, Mattsson E, Nilsson B. Volume blood flow measurements with transit time flowmeter: An in vivo and in vitro variability and validation study. Clin Physiol 1993; 13(5): 547–557.

25. Charbel FT, Hoffman WE, Misra M, Ostergren L. Ultrasonic perivascular flow probe: Technique and application in neurosurgery. Neurol Res 1998; 20(5): 439–442.

26. Amin-Hanjani S, Du X, Mlinarevich N, Meglio G, Zhao M, Charbel F. The cut flow index: an intraoperative predictor of the success of extracranial-intracranial bypass for occlusive cerebrovascular disease. Neurosurgery 2005; 56 (Suppl 1): 75–85.

27. Tovaryš F. Zkušenosti s extra-intrakraniální arteriální anastomózou. Cesk Slov Neurol N 1983; 46/79(5): 311–315.

28. Gajdošová D, Papierniková E, Palkovič Š. Elektroencefalografická a rengenologická kontrola mikroanastomózy. Cesk Slov Neurol N 1983; 46/79(2): 120–124.

29. Krahulík D, Vaverka M, Herzig R, Hluštík P, Houdek M.Extra-intrakraniální arteriální mikroanastomóza. Cesk Slov Neurol N 2009; 72/105(2): 142–146.

30. Sameš M, Bartoš R, Vachata P, Zolal A, Cihlář F, Derner M et al. Hodnocení cerebrovaskulární rezervní kapacity po EC-IC bypassu pomocí TCD. Cesk Slov Neurol N 2009; 72/105(4): 359–363.

31. Horn P, Scharf J, Peňa-Tapia P, Vajkoczy P. Risk of intraoperative ischemia due to temporary vessel occlusion during standard extracranial-intracranial bypass surgery. J Neurosurg 2008; 108(3): 464–469.

32. Ackland DR. Tests of patency. In: Ackland DR (ed). Practice Manual for Microvascular Surgery. 2nd ed. St. Louis, Washington, D.C., Toronto: Mosby 1989: 73–76.

33. Benes V, Netuka D, Charvát F, Mohapl M. Recanalization of Long-lasting Middle Cerebral Artery Occlusion by a Combination of Surgical and Interventional Approaches: Technical Case Report. Neurosurgery 2005; 57 (Suppl 3): 401.

34. Barrow DL, Boyer KL, Joseph GJ. Intraoperative angiography in the management of neurovascular disorders. Neurosurgery 1992; 30(2): 153–159.

35. Meguro K, Tsukada A, Matsumura A, Matsuki T, Nakada Y, Nose T. Portable digital subtraction angiography in the operating room and intensive care unit. Neurol Med Chir (Tokyo) 1991; 31(12): 768–772.

36. Yanaka K, Fujita K, Noguchi S, Matsumaru Y, Asakawa H, Anno I, et al. Intraoperative Angiographic Assessement of Graft Patency During Extracranial-Intracranial Bypass Procedures. Neurol Med Chir (Tokyo) 2003; 43(10): 509–513.

37. Woitzik J, Horn P, Vajkoczy P, Schmiedek P. Intraoperative control of extracranial-intracranial bypass patency by near-infrared incocyanine green videoangiography. J Neurosurg 2005; 102(4): 692–698.

38. Eden A. Doppler techniques and neurosurgery. Neurosurgical Rev 1984; 7(2–3): 193–197

39. Gosling RG, King DH. Arterial assessment by Doppler-shift ultrasound. Proc R Soc Med 1974; 67(1): 447–449.

40. Aleksic M, Heckenkamp J, Gawenda M, Brunkwall J.Pulsatility index determination by flowmeter measurement: a new indicator for vascular resistance? Eur Surg Res 2004; 36(6): 345–349.