BACKGROUND AND IMPORTANCE: Extracranial-intracranial bypass remains an enduring procedure for a select group of patients suffering from steno-occlusive cerebrovascular disease. Although the superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is most familiar among neurosurgeons, particular circumstances preclude the use of an STA donor. In such cases, alternative revascularization strategies must be pursued. CLINICAL PRESENTATION: A 63-year-old female presented with symptoms of hemodynamic insufficiency and was found to have left common carotid artery occlusion at the origin. She experienced progressive watershed ischemia and pressure-dependent fluctuations in her neurological examination despite maximum medical therapy. The ipsilateral STA was unsuitable for use as a donor vessel. We performed an extracranial vertebral artery (VA) to MCA bypass with a radial artery interposition graft. CONCLUSION: This technical case description and accompanying surgical video review the relevant anatomy and surgical technique for a VA-MCA bypass. The patient was ultimately discharged home at her preoperative neurological baseline with patency of the bypass. The VA can serve as a useful donor vessel for cerebral revascularization procedures in pathologies ranging from malignancies of the head and neck to cerebral aneurysms and cerebrovascular steno-occlusive disease.

• MeSH
• arteria carotis interna chirurgie   MeSH
• arteria cerebri media diagnostické zobrazování   chirurgie   MeSH
• arteria vertebralis diagnostické zobrazování   chirurgie   MeSH
• cerebrovaskulární poruchy * chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• revaskularizace mozku * metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE: Stroke, the second leading cause of death globally, often involves ischemia in the vertebrobasilar territory. This condition is underexplored, despite significant morbidity and mortality risks. The purpose of this study is to present a case of occipital artery to V3 segment vertebral artery bypass, emphasizing the role of quantitative magnetic resonance angiography (qMRA) in assessing flow and guiding surgical intervention. METHODS: A 66-year-old man with bilateral vertebral artery occlusion presented acute symptoms. qMRA was employed to evaluate flow dynamics and determine the feasibility of a flow augmentation bypass surgery. The occipital artery to left vertebral artery bypass (OA-to-VA) was performed, utilizing an inverted hockey-stick incision and an antegrade inside-out technique. The patency of the bypass was confirmed using both Doppler probe and Indocyanine green. RESULTS: Postoperative assessments, including computed tomography angiography (CTA) and qMRA, demonstrated the patency of the bypass with improved flow in the basilar artery and left vertebral artery. The patient's condition remained stable postoperatively, with residual peripheral palsy of the left facial nerve. CONCLUSION: In conclusion, the presented case illustrates the efficacy of the OA-to-VA bypass in addressing symptomatic bilateral vertebral artery occlusion. The study underscores the pivotal role of qMRA in pre- and postoperative assessments, providing noninvasive flow quantification for diagnostic considerations and long-term follow-up in patients with vertebrobasilar insufficiency.

• MeSH
• arteria vertebralis * chirurgie   diagnostické zobrazování   MeSH
• lidé MeSH
• magnetická rezonanční angiografie * metody   MeSH
• revaskularizace mozku * metody   MeSH
• senioři MeSH
• vertebrobazilární insuficience * chirurgie   diagnostické zobrazování   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

A 58-year-old patient presented with a severe neurological deficit due to a stroke caused by an occlusion of the left internal carotid artery siphon. Standard treatment failed and neurosurgical consult was delayed. Because of a favorable perfusion imaging finding, microsurgical revascularization via an extra-intracranial bypass (left superficial temporal artery - left middle cerebral artery) was performed 36 hours after the onset of the symptoms. The outcome of the patient was favorable. The authors want to emphasize the need to actively seek patients with a severe neurological deficit and still viable brain tissue. The time window and treatment alternatives are discussed.

• MeSH
• arteria carotis interna chirurgie   MeSH
• cévní mozková příhoda * diagnostické zobrazování   etiologie   chirurgie   MeSH
• ischemická cévní mozková příhoda * komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• perfuze škodlivé účinky   MeSH
• revaskularizace mozku * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Indications for flow diversion stent (FDS) treatment are expanding. However, there is still a lack of evidence for the long-term outcome in distally located aneurysms in the M2 segment of the middle cerebral artery (MCA) and beyond. METHODS: Consecutive subjects (from June 2013 to August 2020) with MCA aneurysms in the M2 segment or beyond treated with FDS were reviewed retrospectively. The primary endpoints for clinical safety were the absence of mortality, stroke event, re-rupture of the aneurysm, and worsening of clinical symptoms. The primary endpoint for treatment efficacy was complete/near-complete occlusion at follow-up after 12 months. RESULTS: 23 patients were identified: 7 aneurysms were located in the M2 segment of the MCA, 4 in the M2-M3 bifurcation, 2 in M3, 3 in M3-4 branching, and 2 in M4; 5 aneurysms were located in M2 with extension into the M1-M2 bifurcation. 13 aneurysms were of fusiform morphology, 8 sacculofusiform, and 2 saccular. 16 aneurysms were of highly suspected dissecting etiology. The median diameter of the parent vessel was 2.1 mm proximally and 2 mm distally. The median time of the follow-up was 30 months (range 16 months to 6 years). Complete/near complete occlusion was observed in 14/20 patients (70%) and one stable remodeling (5%) was seen at 12 months. 22 patients (95.6%) had an excellent clinical outcome (mRS 0-1) at 6 months. Technical challenges associated with the deployment of FDS occurred in 8.7% of cases. Severe complications, intraparenchymal hemorrhage and re-rupture of the aneurysm occurred in 2 patients (8.7%). CONCLUSION: Flow diversion of distally located aneurysms is technically feasible with low morbidity and mortality.

• MeSH
• arteria cerebri media diagnostické zobrazování   chirurgie   MeSH
• cévní mozková příhoda diagnostické zobrazování   etiologie   chirurgie   MeSH
• dospělí MeSH
• endovaskulární výkony škodlivé účinky   metody   trendy   MeSH
• intrakraniální aneurysma diagnostické zobrazování   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• následné studie MeSH
• pooperační komplikace diagnostické zobrazování   etiologie   MeSH
• retrospektivní studie MeSH
• revaskularizace mozku škodlivé účinky   metody   trendy   MeSH
• samoexpandibilní metalické stenty * škodlivé účinky   trendy   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

Nemoc moymoya je bilaterální progredující stenookluzivní postižení distální vnitřní karotidy doprovázené tvorbou bazálních kolaterál a finálně exkluzivní kolateralizací z povodí zevní karotidy. Progresi choroby postihuje angiografická klasifikace Suzukiho. Etiologie není známa, pravděpodobně se jedná o kombinaci vrozených a autoimunitních faktorů. Postihuje především asijskou populaci. Příznaky u dětských pacientů jsou ischemické, u dospělých je častým projevem krvácení. Prognóza bývá špatná. Terapie je výlučně chirurgická, buď v podobě direktního extra-intrakraniálního bypassu nebo indirektní revaskularizace, která využívá potenciál neoangiogeneze z vaskularizovaných tkání v okolí mozku. Kombinace direktní a indirektní revaskularizace představuje optimální léčbu u symptomatických pacientů.

Moyamoya disease is bilateral progressive steno-occlusive impairment of the distal internal carotid artery accompanied by the formation of basal collaterals and finally by the exclusive collateralization from the territory of the external carotid artery. Suzuki angiographic classification describes progression of moyamoya disease. Aetiology is not known, but it is probably a combination of inherited and autoimmune factors. Asian population is mostly affected. Ischemic symptoms are typical in a pediatric population, and in adults, haemorrhage is a frequent symptom. Prognosis is poor. Therapy is exclusively surgical, either direct extra-intracranial bypass or indirect revascularization. Indirect techniques utilize potential of neoangiogenesis of vascularized tissue in the proximity of the brain. Combination of direct and indirect revascularization represents optimal treatment of symptomatic patients.

• MeSH
• lidé MeSH
• moyamoya nemoc * chirurgie   epidemiologie   etiologie   MeSH
• revaskularizace mozku metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

• MeSH
• arteria carotis interna chirurgie   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci arterie carotis chirurgie   MeSH
• prasklé aneurysma * chirurgie   MeSH
• revaskularizace mozku * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

Background: Optimal surgical treatment of blood-blister aneurysms (BBA) remains controversial. Some surgeons prefer clipping reconstruction while others favor primary bypass with trapping. Objective: To analyze of benefit of double bypass technique to surgical outcomes in patients with ruptured BBA in poor initial neurological condition (PINC). Methods: Retrospective analysis of clinical, radiological, and surgical data in 9 patients treated between January 2009 and December 2015. Intraoperative middle cerebral artery blood pressure (MCABP) measurement was used for selection of bypass procedure. Results: Seven patients presented with World Federation of Neurosurgical Societies (WFNS) subarachnoid hemorrhage (SAH) score 4 or 5. No pulse pressure in the MCA after internal carotid artery (ICA) clamping was found in 3 patients, although their ACoA or PCoA were well visualized on preoperative angiograms. By contrast, only a minimal drop in MCABP following ICA clamping was detected in two cases, although their collaterals were slim/nonvisualized on imaging. Although angiographic vasospasms were not observed in our patients, two of them experienced cerebral infarction, attributable more to the mass effect and postoperative ICA thrombosis than to SAH-induced vasospasm. There were 2 premature intraoperative ruptures, but no perioperative mortality, aneurysm recurrence, or rebleeding. Five patients with WFNS SAH score 4 or 5 achieved favorable outcomes. Conclusion: Early double bypass technique guided by MCABP measurement and combined with trapping (or rarely clipping) seems to be a safe method with excellent long-term outcomes in patients in PINC. This study may thus contribute to the debate on the optimal treatment strategy for BBA.

• MeSH
• intrakraniální aneurysma * chirurgie   MeSH
• lidé MeSH
• nemoci arterie carotis chirurgie   MeSH
• nemoci nervového systému komplikace   MeSH
• prasklé aneurysma chirurgie   MeSH
• revaskularizace mozku * metody   MeSH
• subarachnoidální krvácení chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• klinická studie MeSH
• práce podpořená grantem MeSH

• MeSH
• cystická onemocnění ledvin diagnostické zobrazování   MeSH
• dospělí MeSH
• intraventrikulární krvácení do mozku etiologie   terapie   MeSH
• lidé MeSH
• moyamoya nemoc * diagnóza   patologie   terapie   MeSH
• počítačová rentgenová tomografie metody   MeSH
• revaskularizace mozku metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND AND OBJECTIVE: The main challenge of bypass surgery of complex MCA aneurysms is not the selection of the bypass type but the initial decision-making of how to exclude the affected vessel segment from circulation. To this end, we have previously proposed a classification for complex MCA aneurysms based on the preoperative angiography. The current study aimed to validate this new classification and assess its diagnostic reliability using the giant aneurysm registry as an independent data set. METHODS: We reviewed the pretreatment neuroimaging of 51 patients with giant (> 2.5 cm) MCA aneurysms from 18 centers, prospectively entered into the international giant aneurysm registry. We classified the aneurysms according to our previously proposed Berlin classification for complex MCA aneurysms. To test for interrater diagnostic reliability, the data set was reviewed by four independent observers. RESULTS: We were able to classify all 51 aneurysms according to the Berlin classification for complex MCA aneurysms. Eight percent of the aneurysm were classified as type 1a, 14% as type 1b, 14% as type 2a, 24% as type 2b, 33% as type 2c, and 8% as type 3. The interrater reliability was moderate with Fleiss's Kappa of 0.419. CONCLUSION: The recently published Berlin classification for complex MCA aneurysms showed diagnostic reliability, independent of the observer when applied to the MCA aneurysms of the international giant aneurysm registry.

• MeSH
• arteria cerebri media diagnostické zobrazování   chirurgie   MeSH
• intrakraniální aneurysma diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• mozková angiografie * MeSH
• neurozobrazování * MeSH
• registrace MeSH
• reprodukovatelnost výsledků MeSH
• revaskularizace mozku metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The optimal surgical strategy for treating internal carotid artery (ICA) blood blister-like aneurysms (BBAs) has remained unclear. Although some have preferred bypass surgery, others have favored less-demanding surgical methods. The aim of the present meta-analysis was to assess the efficacy, safety, and outcomes of bypass and non-bypass surgical methods when intended as primary treatment of ICA BBAs. METHODS: Studies reporting data on the outcomes of interest for surgically treated patients with ICA BBAs were searched for in the PubMed/MEDLINE, Evidence-Based Medicine Reviews, Cochrane Central, ProQuest, and Scopus databases. The data were analyzed using random effects modeling. RESULTS: Seven observational studies involving 140 patients met the inclusion criteria. The patients treated with bypass surgery, compared with those treated with non-bypass techniques, had lower odds of poor outcomes (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.28-2.02; P = 0.57; I2 = 0%), postoperative vasospasm (OR, 1.73; 95% CI, 0.38-7.92; P = 0.48; I2 = 19%), intraoperative bleeding (OR, 3.37; 95% CI, 0.82-13.90; P = 0.09; I2 = 0%), postoperative bleeding (OR, 1.91; 95% CI, 0.47-7.76; P = 0.36; I2 = 0%), and postoperative recurrence of BBAs (OR, 2.16; 95% CI, 0.54-8.66; P < 0.28; I2 = 0%). No comparison, however, achieved statistical significance. CONCLUSIONS: For surgeons who use both bypass and non-bypass surgical strategies, the 2 methods seemed comparable in terms of the outcomes of interest, although the bypass technique appeared superior. However, comparisons with studies reporting bypass as the uniquely preferred technique have indicated that specialization in, and preference for, the bypass procedure has been associated with more favorable outcomes.

• MeSH
• aneurysma chirurgie   MeSH
• bezpečnost pacientů MeSH
• lidé MeSH
• nemoci arterie carotis chirurgie   MeSH
• neurochirurgické výkony škodlivé účinky   metody   MeSH
• revaskularizace mozku metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH