Neurosurgical focus · 2025
Techniques and application in anterior cerebral artery-radial artery-middle cerebral artery bypass for complex middle cerebral artery aneurysms: donor selection, anastomosis technique, and clinical outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
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Liu Peixi, An Qingzhu, Shen Shiyu, Shi Yuan, Liu Yingtao, Zhu Wei
Аннотация
OBJECTIVE: The aim of this study was to evaluate the feasibility, surgical techniques, and clinical outcomes of anterior cerebral artery (ACA) to middle cerebral artery (MCA) bypass using a radial artery (RA) graft in the treatment of complex MCA aneurysms.
METHODS: A retrospective review was conducted on 11 patients with complex MCA aneurysms who underwent ACA-RA-MCA bypass between 2019 and 2025. Surgical details, intraoperative monitoring data, perioperative complications, and long-term graft patency and neurological outcomes were analyzed. Computational flow simulations were performed in selected cases to assess bypass flow rate.
RESULTS: All patients (mean age 46.7 [SD 18.6] years) underwent ACA-RA-MCA bypass in a hybrid operating room setting. The A1 segment of the ACA was selected as the donor in 10 cases and the A2 segment in 1 case. Superficial temporal artery-MCA bypass was used as a supplementary or salvage treatment in 2 patients. Immediate graft patency was achieved in 9 patients. Two aneurysms required revision for intraoperative occlusion. No surgical deaths occurred. Infarction related to M1 perforator involvement was observed in 5 patients, whereas no infarctions occurred in ACA territories. At final follow-up (range 3-30 months), 9 patients had a modified Rankin Scale (mRS) score of 0-2 and 2 patients had an mRS score of 4. Long-term graft patency was 100%, and complete aneurysm obliteration was achieved in all cases.
CONCLUSIONS: ACA-RA-MCA bypass is a safe and durable revascularization option for selected complex MCA aneurysms, especially those unsuitable for direct clipping or flow diversion. The use of the ACA as a donor provides favorable hemodynamic and intraoperative flexibility, particularly when performed in a hybrid operating room. Despite risks of perforator-related ischemia, mastering and understanding this surgical technique still remains critically important and necessary in the treatment of complex MCA aneurysms.
METHODS: A retrospective review was conducted on 11 patients with complex MCA aneurysms who underwent ACA-RA-MCA bypass between 2019 and 2025. Surgical details, intraoperative monitoring data, perioperative complications, and long-term graft patency and neurological outcomes were analyzed. Computational flow simulations were performed in selected cases to assess bypass flow rate.
RESULTS: All patients (mean age 46.7 [SD 18.6] years) underwent ACA-RA-MCA bypass in a hybrid operating room setting. The A1 segment of the ACA was selected as the donor in 10 cases and the A2 segment in 1 case. Superficial temporal artery-MCA bypass was used as a supplementary or salvage treatment in 2 patients. Immediate graft patency was achieved in 9 patients. Two aneurysms required revision for intraoperative occlusion. No surgical deaths occurred. Infarction related to M1 perforator involvement was observed in 5 patients, whereas no infarctions occurred in ACA territories. At final follow-up (range 3-30 months), 9 patients had a modified Rankin Scale (mRS) score of 0-2 and 2 patients had an mRS score of 4. Long-term graft patency was 100%, and complete aneurysm obliteration was achieved in all cases.
CONCLUSIONS: ACA-RA-MCA bypass is a safe and durable revascularization option for selected complex MCA aneurysms, especially those unsuitable for direct clipping or flow diversion. The use of the ACA as a donor provides favorable hemodynamic and intraoperative flexibility, particularly when performed in a hybrid operating room. Despite risks of perforator-related ischemia, mastering and understanding this surgical technique still remains critically important and necessary in the treatment of complex MCA aneurysms.