Article
Practice trends in intracranial bypass surgery in a 21-year experience
Trends in derintrakraniellen Bypasschirurgiebasierend aufeiner 21-jährigen Praxiserfahrung
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Authors
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Jan-Karl Burkhardt
- Baylor College of Medicine, Neurosurgery, Houston, United States
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Michael T. Lawton
- Barrow Neurological Institute, Department of Neurosurgery, Phoenix, AZ, United States
| Published: | May 8, 2019 |
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Outline
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Objective: Many intracranial bypass types are available for cerebral flow preservation or flow augmentation. The aim of this study was to analyze practice trends in specific bypass types from a large bypass experience.
Methods: This retrospective review of a prospectively maintained database included all intracranial bypasses performed by a single surgeon over 21 years. Bypass types were grouped into 7 categories: type 1 = extracranial-to-intracranial (EC-IC) bypass with scalp arteries as donors; type 2 = EC-IC bypass with an interposition graft to the cervical carotid arteries; type 3 = arterial reimplantation; type 4 = in situ bypass; type 5 = reanastomosis; type 6 = intracranial-to-intracranial (IC-IC) bypass with interposition graft; and type 7 = combination bypass. Practice trends were analyzed in seven 3-year time intervals over a 21-year period.
Results: In total, 598 intracranial bypasses were performed including 359 type 1 (60%), 59 type 2 (9.9%), 24 type 3 (4%), 30 type 4 (5%), 37 type 5 (6.2%), 36 type 6 (6%) and 53 type 7 (8.9%), respectively. While type 1 and 7 bypasses increased, a decrease in type 2 bypasses and an increase in type 3-6 bypasses were observed. The highest bypass volume was observed in patients treated for aneurysms, (n=250, 41.8%) followed by moyamoya disease (n=190, 31.8%) and intracranial vessel stenosis or occlusion (n=149, 24.9%). Endovascular treatment failure was observed in 10.8% of the aneurysm patients treated with a bypass procedure.
Conclusion: Intracranial bypass remains an essential technique for open vascular neurosurgeons to treat a variety of vascular diseases. In this series, increases in simple EC-IC bypass and more complex combination bypasses were observed, while the classic EC-IC interpositional bypass decreased over time. Changing bypass types over time reflect the increasing use of flow diverters as well as the need for surgical revascularization for complex aneurysms and those that failed previous endovascular therapy.
