Influence of Patient and Technical Variables on Combined Direct and Indirect Cerebral Revascularization: Case Series.

Autor:	Rennert RC; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA., Brandel MG; Department of Neurological Surgery, University of California San Diego, San Diego, California, USA., Budohoski KP; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA., Twitchell S; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA., Fredrickson VL; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA., Grandhi R; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA., Couldwell WT; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Jazyk:	angličtina
Zdroj:	Operative neurosurgery (Hagerstown, Md.) [Oper Neurosurg (Hagerstown)] 2023 Jun 01; Vol. 24 (6), pp. 610-618. Date of Electronic Publication: 2023 Feb 13.
DOI:	10.1227/ons.0000000000000618
Abstrakt:	Background: Cerebral bypass for flow augmentation is an important technique for selected neurosurgical patients, with multiple techniques used (direct, indirect, or combined). Objective: To assess the impact of patient and technical variables on direct and indirect bypass flow after combined revascularization. Methods: This was a retrospective, single-institution review of patients undergoing direct superficial temporal artery-to-middle cerebral artery bypass with indirect encephaloduro-myosynangiosis for moyamoya disease and steno-occlusive cerebrovascular disease over a 2-year period. We evaluated the effect of baseline patient characteristics, preoperative imaging characteristics, and operative variables on direct and indirect patency grades. Results: Twenty-six hemispheres (8 moyamoya disease and 18 steno-occlusive cerebrovascular disease) in 23 patients were treated with combined revascularization. The mean patient age was 53.4 ± 19.1 years. Direct bypass patency was 96%. Over a mean follow-up of 8.3 ± 5.4 months, there were 3 strokes in the treated hemispheres (11.5%). The mean modified Rankin Scale score improved from 1.3 ± 1.1 preoperatively to 0.7 ± 0.8 postoperatively. Preservation of the nondonor superficial temporal artery branch was associated with a lower direct bypass grade ( P < .01), whereas greater mean time to maximum perfusion (Tmax)> 4 and >6 seconds and mismatch volumes were associated with higher direct bypass grades ( P < .05). Tmax >4-second volume inversely predicted indirect bypass patency. Conclusion: Patient and technical variables may influence the relative contributions of the direct and indirect components of combined revascularizations. (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)
Databáze:	MEDLINE
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