TITLE:
Superficial Temporal Artery to Middle Cerebral Artery Bypass and Endovascular Parent Artery Occlusion in the Treatment of Giant Intracranial Aneurysms
AUTHORS:
Aurélien Ndoumbe, Aimée Redondo
KEYWORDS:
Giant Cerebral/Intracranial Aneurysm, Superficial Temporal Artery to Middle Cerebral Artery Bypass, Balloon Test Occlusion, Parent Artery Occlusion, Flow-Diversion
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.8 No.2,
March
26,
2018
ABSTRACT: The authors are reporting on a study drawn from
unpublished dissertation done by the corresponding author when he completed his
neurosurgical training in Paris, France in 2004, few years before the advent of
flow diverters. The study was a retrospective review of giant intracranial
aneurysms treated by superficial temporal artery to middle cerebral artery
bypass combined with endovascular occlusion of the parent artery. From 1990 to
2003, 29 consecutive cases of giant cerebral aneurysms, not suitable to
selective treatment were managed in that way. Twenty-one medical records had
enough data to allow objective evaluation. Sixteen female and five male
patients bearing 21 giant aneurysms were involved. Their mean age was 46 years.
The aneurysm was revealed by mass effect in 13 cases and subarachnoid
hemorrhage in one case. On admission 19 patients presented with unruptured
aneurysms and two have sustained a subarachnoid hemorrhage. The balloon
occlusion test before the bypass operation was not tolerated in 18 patients.
The treatment was completed in 19 patients and 17 of them had parent artery occlusion with latex detachable
balloons. The only death of the series occurred before the endovascular treatment. The mean follow-up period
was 30 months. After completion of the treatment, 16 (84%) patients had no
symptom. Aneurysm recanalization or rupture was not observed after the parent
artery occlusion. With the combination of superficial temporal artery to middle
cerebral artery bypass + endovascular parent artery occlusion, 90% of giant
intracranial aneurysms untreatable selectively were permanently excluded with a
good outcome in 95%.