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High-flow bypass with radial artery graft followed by internal carotid artery ligation for large or giant aneurysms of cavernous or cervical portion: clinical results and cognitive performance

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Abstract

High-flow bypass followed by ligation of the internal carotid artery (ICA) is an effective treatment, but the impact of abrupt occlusion of the ICA is unpredictable, especially on postoperative cognitive function. The present study evaluated the clinical results as well as cognitive performances after high-flow bypass using radial artery graft (RAG) with supportive superficial temporal artery (STA)-middle cerebral artery (MCA) bypass, followed by ICA ligation. Ten consecutive patients underwent high-flow bypass surgery for large or giant ICA aneurysms of cavernous or cervical portion. Demographics, clinical information, magnetic resonance (MR) imaging, computed tomography, digital subtraction angiography (DSA), intraoperative somatosensory evoked potentials, neuropsychological examinations including the Wechsler Adult Intelligence Scale-Third Edition and the Wechsler Memory Scale-Revised (WMS-R), and follow-up data were analyzed. The aneurysm was located on the cavernous segment in eight cases and cervical segment in two cases, and mean aneurysm size was 27.9 mm. Postoperative DSA demonstrated robust bypass flow from the external carotid artery to MCA via the RAG, and no anterograde flow into the aneurysm. No patient showed new symptoms after the operation. Follow-up clinical study and MR imaging were performed in nine patients and showed no additional ischemic lesion compared with preoperative imaging. Seven patients completed neuropsychological examinations before and after surgery. All postoperative scores except WMS-R composite memory score slightly improved. High-flow bypass followed by ICA ligation can achieve good clinical outcomes. Successful high-flow bypass using RAG with supportive STA-MCA bypass and ICA ligation does not adversely affect postoperative cognitive function.

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Abbreviations

BOT:

balloon occlusion test

CCA:

common carotid artery

CT:

computed tomography

DSA:

digital subtraction angiography

DWI:

diffusion-weighted magnetic resonance imaging

ECA:

external carotid artery

ICA:

internal carotid artery

MCA:

middle cerebral artery

MR:

magnetic resonance

PIQ:

performance intelligence quotients

RAG:

radial artery graft

SSEPs:

somatosensory evoked potentials

STA:

superficial temporal artery

T2WI:

T2-weighted magnetic resonance imaging

VIQ:

verbal intelligence quotients

WAIS-III:

Wechsler Adult Intelligence Scale-Third Edition

WMS-R:

Wechsler Memory Scale-Revised

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Correspondence to Hideaki Ono.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ono, H., Inoue, T., Tanishima, T. et al. High-flow bypass with radial artery graft followed by internal carotid artery ligation for large or giant aneurysms of cavernous or cervical portion: clinical results and cognitive performance. Neurosurg Rev 41, 655–665 (2018). https://doi.org/10.1007/s10143-017-0911-3

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  • DOI: https://doi.org/10.1007/s10143-017-0911-3

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