Pdf the superficial temporal artery trunk as a donor. Given its high spatial and temporal resolution, icgva has been widely established as a useful technique to perform a qualitative analysis of the graft patency during revascularization procedures. Flowassisted surgical technique in cerebrovascular surgery. Less invasive technique for ecic bypass springerlink. Pdf usefulness of needle holder with a function of fine. Financial support was provided by the dr ralph and marian falk research trust foundation. Sakuma j, suzuki k, sasaki t, matsumoto m, oinuma m, kawakami m, et al.
Suture retraction technique to prevent parent vessel. Microsurgical clip obliteration of middle cerebral aneurysm using. Measurement of volume flow rates in major cerebral vessels can be used to evaluate the hemodynamic effects of cerebrovascular disease. Microscopeintegrated nearinfrared nir indocyanine green videoangiography icg va is a new technique of bloodflow measurement that has recently been applied to neurosurgy. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Dr aminhanjani receives grant support from the national institutes of healthnational institute of neurological disorders and stroke and material research support no direct funds from ge healthcare and vassol, inc. In this paper we developed a new ct based grading system for distinguishing ansah vs. In a doublebarrel stamca bypass, however, both branches of the sta are utilized. Guidelines for the management of patients with unruptured. Traumatic cerebral aneurysms secondary to penetrating intracranial injuries. Pdf changes in bypass flow during temporary occlusion of. Effect of hemodynamics on stroke risk in symptomatic. Surgery intern microsurgery fellowship henry ford hospital detroit, michigan clinical fellow montreal neurologic institute mcgill university montreal, quebec, canada residency. Treatment of unusually located traumatic intracranial.
Frontiers applications of microscopeintegrated indocyanine. An intraoperative predictor of the success of extracranialintracranial bypass for occlusive cerebrovascular disease. Cfd showed increased wall pressure, decreased wall shear. Neurochirurgie vol 50, issue 5, pages 500612 november. The anastomosis of small vessels is an established approach in the treatment of complex intracranial aneurysms, cranial base tumors, and cerebral revascularization 1, 2, 9, 22, 28, 32. The superficial temporal artery sta is the mainstay of donor vessels for extracranialintracranial bypass in cerebral revascularization. A retrospective study in microsurgical procedures of large. However, the typically used sta anterior or posterior branch is not always adequate in its flowcarrying capacity. Festa jr, schwarz lr, pliskin n, cullum cm, lacritz l, charbel ft, mathews d, starke rm, connolly es, marshall rs, lazar rm.
Delayed loss of motor evoked potentials during cerebral. Dr alaraj is a consultant of cordiscodman and received research grant from the national institutes of health. Flow rates in the 15 major cerebral arteries were measured on retrospectively gated fast 2d phasecontrast mr angiography obtained in 83 healthy adult volunteers age range, 2474 years. To evaluate the in vivo accuracy of qmra for measuring the effects of progressive arterial stenosis, we compared this technique with invasive flow measurements from a sonographic transittime flow. As a service to our customers we are providing this early version of the manuscript. The superficial temporal artery trunk as a donor vessel in cerebral. Heel suturing on the donor vessel prior to arteriotomy for endtoside. Against this background, it is remarkable that at present, only three randomized controlled trials rcts exist in the field, both dealing with extracranial to intracranial bypass surgery for flow augmentation in patients at risk to. There is much debate regarding the optimal strategy for extracranialintracranial ecic bypass for complex aneurysms. Superficial temporal arterytomiddle cerebral artery bypass. Usefulness of needle holder with a function of fine. Carter 1, christopher farrell 1, christopher owen 1 1 department of neurosurgery, havard medical school, massachusetts general hospital. Clip readjustment in aneurysm surgery after flow evaluation using the ultrasonic perivascular probe.
The superficial temporal artery trunk as a donor vessel in cerebral revascularization. In vivo evaluation of quantitative mr angiography in a canine. Members of the congress and nonmember subscribers receive 3000 pages per year packed with the very latest science, technology, and medicine, not to mention fulltext online access to the worlds most complete, uptotheminute neurosurgery. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Evaluation of blood flow is an important component of assessing patients with cerebrovascular disease.
With the advent and rapid advances in endovascular technologies, the pathologies that are brought to surgical attention are increasingly complex. Cerebrovascular surgery is a technically challenging subspecialty of neurosurgery. Donor selection in flow replacement bypass surgery for. The 11 oclock heel first technique for microvascular endtoside. Twostage carotid saphenous vein interposition graft and. Microsurgical clip obliteration of middle cerebral aneurysm. Use of cervical spinal cord stimulation in treatment and.
Cerebral revascularization using cadaveric vein grafts. Largevessel cerebral blood flow quantification has emerged as a potential predictor of stroke risk. Rupture after bypass and distal occlusion of giant. Aminhanjani s, du x, mlinarevich n, meglio g, zhao m. Aneurysm rupture can occur after bypass and distal occlusion, despite initial appearances of intraoperative stability. Charbel fady t is an angiographically obliterated aneurysm always secure. We sought to derive regional cerebral blood flow using vessel flows from quantitative mr angiography qmra. Ligation of the unused sta branch after completion of anastomosis does not contribute to improvement in bypass flow immediately after surgery, and furthermore, carries some risk of skin necrosis. The strategy to achieve this utilizes direct intraoperative flow measurements to guide optimal revascularization by matching graft flow. Risk of intraoperative ischemia due to temporary vessel. Balloon angioplasty is often performed for symptomatic vasospasm following aneurysmal subarachnoid hemorrhage. In vivo evaluation of quantitative mr angiography in a canine carotid artery stenosis model. While medical therapy may reduce the risk of stroke, it does not completely eliminate it.
Safety and efficacy of balloon angioplasty of the anterior. Cerebral blood flow cbf can be assessed with imaging techniques, which focus on evaluating regional cbf at the tissue level using modalities such as single positron emission tomography, xenon computed tomography, positron emission tomography, and computed tomography. P015 a new grading system for predicting angiogram. Charbel ft, meglio g, aminhanjani s 2005 superficial temporal arteryto middle cerebral artery bypass. We suggest that the mechanisms are not a simple pressure within the dome and may be due to rapid thrombosis with subsequent aneurysm wall destabilization or stretching and capacitance causing persistent filling. Oct 01, 2009 cerebral revascularization using cadaveric vein grafts cerebral revascularization using cadaveric vein grafts mery, francisco j aminhanjani, sepideh. Rodolfo gabriel gatto, md, phd university of illinois at. Protective stamca bypass to prevent brain ischemia during. Hemodynamic characteristics of cerebral arteriovenous. An 83yearold woman with no history of comorbidities or family history of aneurysms was incidentally detected to have a large left vertebral artery va posterior inferior cerebellar artery pica segment aneurysm 15 mm in size, and its neck of about 10 mm in size on 3dimensional 3d computed tomography angiogram cta of the brain. Occlusion of extracranialintracranial bypass anastomosis.
The role of this operation in the setting of cerebrovascular occlusive disease, with compromised cerebral hemodynamic reserve, is a topic of current invest. Dr aminhanjani reported receiving material research support no direct funds from ge healthcare and vassol inc for the veritas study. Aminhanjani s, du x, mlinarevich n, meglio g, zhao m, charbel ft. The graft is tunneled preauricular through a 28 french chest tube to the neck. Based on past laboratory and anecdotal clinical experience, we hypothesized that prolonged cervical spinal cord stimulation scs in the acute settings of aneurysmal subarachnoid hemorrhage asah would be both safe and feasible, and that 2week stimulation will. Assessing success after cerebral revascularization for ischemia. Flowassisted surgical technique in cerebrovascular surgery flowassisted surgical technique in cerebrovascular surgery aminhanjani, sepideh. Vertebrobasilar flow evaluation and risk of transient. The superficial temporal artery trunk as a donor vessel in. Charbel ft, meglio g, amin hanjani s 2005 superficial temporal arterymca bypass. Frontiers application of fluorescein fluorescence in. Symptomatic vertebrobasilar disease carries a high. Angioplasty of the anterior cerebral artery aca, however, is perceived to be a challenging endeavor and not routinely performed due to technical and safety concerns. Dr charbel received ownership interest from vassol inc and is a consultant of transonic.
Hemodynamics in atherosclerotic vertebrobasilar occlusive. Effect of age and vascular anatomy on blood flow in major. Neurosurgery chief resident university of illinois at chicago chicago, illinois neurosurgery resident henry ford hospital detroit, michigan education medical school st. Superficial temporal arterytomiddle cerebral artery. Since the introduction of cerebral bypass surgery by professor yasargil in 1967, a plethora of literature has been published on direct cerebral revascularization. Superficial temporal artery middle cerebral artery. Microsurgical clip obliteration of middle cerebral aneurysm using intraoperative flow assessment bob s. Sepideh aminhanjani, neurosurgeon in chicago, il us. It has been shown that intraoperative cut flow index postbypass flowfree cut flow measurements and postanastomosis flow assessments are highly predictive for the success rate of the bypass. Aminhanjani s, meglio g, gatto r, bauer a, charbel ft.
The amount of bypass flow in the sta seems to be influenced not by donor vessel status but by recipient vessel demand. Drawn from the clinical expertise of ft charbel, md, s aminhanjani md, univ. In reply we read with interest the letter by walcott et al and thank them for their insightful comments. Fagundespereyra wj, hoffman we, misra m, charbel ft. Changes in bypass flow during temporary occlusion of unused branch of superficial temporal artery. Microvascular anastomosis training model based on a turkey. Zhaos 6 research works with 181 citations and 143 reads, including. In bypass surgery, a singlehanded needle holder is usually used with.
Regional cerebral blood flow using quantitative mr angiography. Dr aminhanjani received research grant from the national institutes of health, and research support no direct funds from ge healthcare, vassol inc. Fluorescein sodium fna is a fluorescent drug with a long history of use for assessing retinal blood flow in ophthalmology. The utility of intraoperative blood flow measurement during aneurysm surgery using an ultrasonic perivascular flow probe. Although both needle holders have a function of fine forceps, there is a difference in the handles. The 2year risk of ipsilateral ischemic stroke following internal carotid artery occlusion icao in a patient undergoing maximal medical therapy is 58 % per year. Introduction angiogram negative subarachnoid haemorrhage ansah account for about 15% of all nontraumatic sah cases. A flowbased approach to cerebrovascular surgery can help to optimize neurosurgical interventions. A relatively small but nevertheless significant number of neurosurgical procedures incorporate this technique. Spatiotemporal image correlation spectroscopy measurements of. The role of intraoperative indocyanine green video. Charbel ft, meglio g, aminhanjani s 2005 superficial temporal arterytomiddle cerebral artery bypass. A 53yrold male presented with cognitive decline, left extremity weakness, and left visual field blurriness. Extracranialintracranial ecic bypass is used for flow replacement in the treatment of complex cerebral aneurysms or tumors that require vessel sacrifice, and for flow augmentation in the treatment of cerebral ischemia.
Pdf usefulness of needle holder with a function of fine forceps for. Sepideh aminhanjani is a neurosurgeon in chicago, illinois and is affiliated with one hospital. Computed tomographic angiography of headneck demonstrated bilateral cervical internal carotid artery occlusion and magnetic resonance imaging of brain showed a small right parietooccipital lobe infarct. Research scientist with solid experience in neuroimaging and experimental animal models of neurodegenerative diseases and traumatic brain injury. This is a pdf file of an unedited manuscript that has been accepted for publication. In a period of 28 months between january 2004 and april 2006, 39 ecic bypass were performed for hemodynamic compromised patients including 9 patients with moyamoya disease using less invasive technique. Qmra uses phasecontrast techniques to noninvasively measure vessel flows. Download the cerebrovascular literature pack transonic. Aminhanjani s, du x, mlinarevich n, meglio g, zhao m, charbel ft 2005.
Resolution of bilateral moyamoya associated collateral vessel. Conclusion the new ct scan scoring provides an estimate for the. Usefulness of needle holder with a function of fine forceps for bypass surgery in both hands. Nov 01, 2007 flowassisted surgical technique in cerebrovascular surgery flowassisted surgical technique in cerebrovascular surgery aminhanjani, sepideh.
Superficial temporal artery to middle cerebral artery. B, indirect collateral flow to distal right mca territory via right eca dural and scalp branches, 4 mo postoperative dsa, right eca injection, lateral injection. Department of neurosurgery, university of illinois at chicago, chicago, illinois, usa. Effect of adventitial dissection of superficial temporal. A new type of needle holder having fine long jaws as acting fine forceps is recently released from mizuho co. Charbel, the utility of intraoperative blood flow measurement during. Aminhanjani s, du x, mlinarevich n, meglio g, zhao m, charbel ft 2005 the cut flow index. Although the pathogenesis of moyamoya disease mmd has not been fully elucidated, the effectiveness of surgical revascularization in preventing stroke has been addressed by many studies. Intraoperative imaging acta neurochirurgica supplementum. Scribd is the worlds largest social reading and publishing site. Sepideh aminhanjani md, faans, facs, faha faculty and staff. Nov 28, 2019 indocyanine green videoangiography icgva is a nearinfrared range fluorescent marker used for intraoperative realtime assessment of flow in cerebrovascular surgery. Simply select your manager software from the list below and click on download.
Since the 1985 extracranialintracranial ecic bypass study, additional trials have been conducted to further investigate the usefulness. Flowassisted surgical techniques fast and protocols. A flowbased approach to cerebrovascular surgery can help to optimize. Aug 22, 2019 a, involution of right stamca bypass and occlusion of 2 anastomosisassociated aneurysms, 4 mo postoperative dsa, right eca injection, lateral projection. They note that whereas in carotid stenosis, arterytoartery embolism is a common culprit, hypoperfusion as determined by the vertebrobasilar flow evaluation and risk of transient ischemic attack and stroke protocol is the main pathological mechanism in patients with vertebrobasilar. Charbel is a consultant for transonics systems, inc. Complications of cerebral bypass surgery sciencedirect.