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Surgery of the anomalles of the vertebral artery
564
Cerebrovascular Disorders - Cerebral Revascularization
These results show that improvement occurred in patiens with a dynamic deficit (group 2) only. In group I , patients with a fixed deficit, no improvement wasobserved. It is. therefore, concluded that patientswith a dynamicdeficitare favourable candidates for surgeryand that aggressive and rapid diagnostic and therapeutic measures should be undertaken.
IP-1-121 I Reconstruction operations in pathological kinking of carotid arteries
J.V. Biryuchkov, J.V. Belov, M.J. Biryuchkov, MK Jusubaliev, A.B. Aldabergenova. Medical Institute, Aktjbinsk, Kazakhstan, Moskow, Russis We analyzed the results of treatment of 88 patients with pathological kinking of the branches of the aortic arch. The resection of pathological kinkingof the general carotid artery and its branches was earned out in 42 patients, of lhe vertebral artery-in 9, of the subclavian artery in 4 patients; in 10-periarterial sympathectomy, in 4-gangliostellectomy in 5-redressment of the changed knee of the internal carotid artery with the ligation of the left external carotid artery; optimum operation in patients with pathological kinking is the resection at the affectedartery and reconstruction of the straight bloodflow with an end-to-end anastomosis.
IP- 1-1221 Surgery of the anomalies of the vertebral artery L.P. Metyolkina, N.V. Vereschagin, NeurologyAMS, Moscow, Russia
v.v. Peresedov, P.A. Fedin. Instituteof
The anomaly of the vertebral artery (VA)may be the cause of vertebrobasilar insufficiency. Thereis a limitednumber01 publications on diagnosis andsurgery of these diseases. Hundred-and-thirty operations were performed in 100 patients having dizziness, ataxia, headache, and drop-attacks. The topographic characteristics of 79 vertebralarteries in patientswith the vertebral arteryostium displacement were compared with those of 13 VA in 100patientswith non-vascular neurological disorders. Beforeand after surgical treatment all the patients wereinvestigated in detail(standard neurological testing, angiography, sonoqraphy, EEG, EP, CT,RBF, Student-t-test, Kendall coefficient). TIAand noneffective conservative treatment were an indicationfor surgery in patientswith anomaly and deformations of the vertebral artery. Divisionof the scalenus anticus and ligation of the enlarged thyrocervical trunk were performed in patients Wilh the vertebral anery ostium lateral displacement. Intraoperative VA bloodllow was measured in 16 patients before and after ligation of the thyrocervical trunk. The blood flow immediately increased in all cases. We suspected an unusual thyrocervical trunk steal syndrome. Division of the scalenus anticus, arteriolysis and fixation of the vertebral artery was performed in patients with VA kinking. The improvement was 85%, but 15% of neurological symptoms remained unchanged. There were no lethal outcomes or central neurologic deficits among the patientsin our study. The vertebral arteryreconstruction is a successful and safe technique.
1P-1-1231
Arterial reconstruction for vertebral artery stenosis at the origin
K. Yoshino, S. Fujimoto, Y.Terai, N. Kusaka, A. Nishimoto. Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawaken, Japan The usefulness of the percutaneous transluminaJ angioplasty (PTA) and the necessity of the surgicalreconstructions for vertebral artery(VA) stenosis at the origin are discussed. Until Nov. 1992,82 atheromatous VA stenosis at the origin were surgically reconstructed mainly by VA transposition to lhe common carotid artery. After surgery, minor complications such as miosis (45 cases), Horner'ssyndrome (1 case), hoarseness (2 cases)occurred, however, noadditional cerebral ischemic signs were observed. and all anastomosed VAs were patent. After Dec. 1992, surgerywas performed only in 6 caseswith wide-spread stenosis or too severe stenosis in 58 VA stenoses. PTA was applied in 52 remaining cases, and was unsuccessful in 5 cases, insufficient dilatation of the stenosis in 2 cases. Restenosis occurred in 6 cases within 4 months after PTA. In 2 cases, small thalamic infarction occurred30 minutesand 3 hoursafter uneventful procedure of PTA, respectively. Finally surgical reconstructions were performed in 10 of 52 PTA cases for unsuccessful PTA (5 cases), poor dilation (2 cases), and restenosis (2 cases). For reconstruction of VA stenosis at the origin, PTAappears to be a simple, less invasive, and effective method. But we would pay attention to restenosis after PTAand embolism dUring and after PTA. When PTAseemsto be difficult or has turned out unsuccessful. we had betterto select surgery insteadof PTA. We should be familiar not only with PTA but also wilh surgery to achieve good resultsand avoid surgicalcomplications.
Monday, 7 luly 1997
IP-1- 1241 hyperperfusion Low perfusion reserve predicts cerebral induced by surgical revascularization Tetsuyuki Yoshimoto, Kiyohiro Houkin, HiroshiAbe. Departmentof Neurosurgery, Hokkaido University, School of Medicine, Sapporo, Jspsn Introduction: Hyperperfusion syndrome after surgical revascularization is a rare complication. There has been no systematic study on factors thaI predict the hyperperfusion after revascularization surgery. In this paper, retrospective analysis of the factors related to the post-operative hyperperfusion will be investigated. Patients and Methods: 46 cases of surgical revascularization including 33 casesof carotid endanerectomy (CEA)and 13casesof STA-MCA anastomosis are analyzed. Among lhese, there were 3 cases 01 post-operative hyperperfusian syndrome despile at well-controlled blood pressurepost-operatively. Four factors, that is 1) regional cerebral blood flow (rCBF). 2) the increase in the ratio of the post-operative rCBF. 3) cerebral perfusion reserve as shown by the increase of rCBF after acetazolamide administration (to.rCBF) and 4) the difference in meanblood pressure between the preoperative and postoperative stale (to.BP), were analyzed, Results: Preoperative rCBF was signilicanlly lower in cases of hyperperfusionsyndrome thanthecontrolcases(p < 0.01). Moreoverto.rCBF was lower in hyperperfusion cases (p < 0.05). However. there were no apparentdifferences in increase of rCBFand to.BP between the hyperperfusion casesand the control cases. Conclusion: Incasesof marked lowperfusion (lowrCBF)withpoorperfusion reserve, hyperperfusian can take place even if blood pressure is adequately controlled.
IP-1-12S ! Neurosurgical management of cerebellar infarction A. Isla. A. Bendala, B. Bejarano, F. Alvarez, M.G. Blazquez. Service of Neurosurgery, Hospital"La Paz", Madrid, Spain A review was made of eight patients with acute cerebellar ischemia on which surgerywas performed. The dinical findings were cephalea, vomiting and impaired level of consciousness. The type of surgery was in four cases external drainage of the ventricle, in one case ventriculo-peritoneal derivation and in threecasesdecompressive SUb-occipital craniotomy(one of these neededventriculo-peritoneal derivation). We appliedthe surgicaltechniques from major to less complexity in relation to the evolution of the clinical pattern. The results were good in 6 cases and fair in 2 patients who had a dependent outcome.
IP.1-126!
CBF, metabolism and neuropsychological function following bypass surgery for hemodynamic ischemia
Kazuyuki Miura, SohichiTaguchi, Masayuki Funayama, NoriyukiKuwata, AkinoriYabuta, Michiyasu Suzuki, Naohiko Kubo, KiyoshiKuroda, Akira Ogawa. Departmentof Neurosurgery, Iwate Medical University, Morioka, Japan We aimed to evaluate superficial temporal artery to proximal middle cerebral artery anastomosis in patients with hemodynamic ischemia in the anterior cireulatlon, Methods: Tenpatientswith internal carotid occlusion, 4 withmiddlecerebral artery occlusion, and 6 with sever stenosis of middle cerebral artery were selected. They showedno marked low density area on CT,with or without minor neurological deficit. We analyzed CBF & metabolism (restingstate and acetazolamide challenge) pre and postoperatively, using positron emission tomography. (CBF[after challenge]-eBF[restJ)/CBF[restJ) was definedas cerebrovascular reserve capacity (CVRC). We also investigated higher cortical function with Hasegawa-dementia scale-revised (HDS-R). mini-mental state examination (MMS), and Wechsler adult intelligence scale-revised (WAIS-R). Results: Postoperatively, significant improvement was observed on CBF[rest] and CVRC. HD5-R and WAIS-R also significantly imprOVed. In patientswith low scoresof HDS-R(below24), high level of preoperative OEF sig· nificantlydecreased postoperatively, corresponding to improvement of HDS-R scores. Preoperative analysisof WAIS-R showed that performance 10 was significantlyaffected in patients with right lesion, andverbal 10was in patientswith left lesion. Conclusion: STA-proximal MCA anastomosis is possible to ameliorate higherbrainfunction through improvement of CBF and metabolism.
Cerebrovascular Disorders - Cerebral Revascularization
These results show that improvement occurred in patiens with a dynamic deficit (group 2) only. In group I , patients with a fixed deficit, no improvement wasobserved. It is. therefore, concluded that patientswith a dynamicdeficitare favourable candidates for surgeryand that aggressive and rapid diagnostic and therapeutic measures should be undertaken.
IP-1-121 I Reconstruction operations in pathological kinking of carotid arteries
J.V. Biryuchkov, J.V. Belov, M.J. Biryuchkov, MK Jusubaliev, A.B. Aldabergenova. Medical Institute, Aktjbinsk, Kazakhstan, Moskow, Russis We analyzed the results of treatment of 88 patients with pathological kinking of the branches of the aortic arch. The resection of pathological kinkingof the general carotid artery and its branches was earned out in 42 patients, of lhe vertebral artery-in 9, of the subclavian artery in 4 patients; in 10-periarterial sympathectomy, in 4-gangliostellectomy in 5-redressment of the changed knee of the internal carotid artery with the ligation of the left external carotid artery; optimum operation in patients with pathological kinking is the resection at the affectedartery and reconstruction of the straight bloodflow with an end-to-end anastomosis.
IP- 1-1221 Surgery of the anomalies of the vertebral artery L.P. Metyolkina, N.V. Vereschagin, NeurologyAMS, Moscow, Russia
v.v. Peresedov, P.A. Fedin. Instituteof
The anomaly of the vertebral artery (VA)may be the cause of vertebrobasilar insufficiency. Thereis a limitednumber01 publications on diagnosis andsurgery of these diseases. Hundred-and-thirty operations were performed in 100 patients having dizziness, ataxia, headache, and drop-attacks. The topographic characteristics of 79 vertebralarteries in patientswith the vertebral arteryostium displacement were compared with those of 13 VA in 100patientswith non-vascular neurological disorders. Beforeand after surgical treatment all the patients wereinvestigated in detail(standard neurological testing, angiography, sonoqraphy, EEG, EP, CT,RBF, Student-t-test, Kendall coefficient). TIAand noneffective conservative treatment were an indicationfor surgery in patientswith anomaly and deformations of the vertebral artery. Divisionof the scalenus anticus and ligation of the enlarged thyrocervical trunk were performed in patients Wilh the vertebral anery ostium lateral displacement. Intraoperative VA bloodllow was measured in 16 patients before and after ligation of the thyrocervical trunk. The blood flow immediately increased in all cases. We suspected an unusual thyrocervical trunk steal syndrome. Division of the scalenus anticus, arteriolysis and fixation of the vertebral artery was performed in patients with VA kinking. The improvement was 85%, but 15% of neurological symptoms remained unchanged. There were no lethal outcomes or central neurologic deficits among the patientsin our study. The vertebral arteryreconstruction is a successful and safe technique.
1P-1-1231
Arterial reconstruction for vertebral artery stenosis at the origin
K. Yoshino, S. Fujimoto, Y.Terai, N. Kusaka, A. Nishimoto. Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawaken, Japan The usefulness of the percutaneous transluminaJ angioplasty (PTA) and the necessity of the surgicalreconstructions for vertebral artery(VA) stenosis at the origin are discussed. Until Nov. 1992,82 atheromatous VA stenosis at the origin were surgically reconstructed mainly by VA transposition to lhe common carotid artery. After surgery, minor complications such as miosis (45 cases), Horner'ssyndrome (1 case), hoarseness (2 cases)occurred, however, noadditional cerebral ischemic signs were observed. and all anastomosed VAs were patent. After Dec. 1992, surgerywas performed only in 6 caseswith wide-spread stenosis or too severe stenosis in 58 VA stenoses. PTA was applied in 52 remaining cases, and was unsuccessful in 5 cases, insufficient dilatation of the stenosis in 2 cases. Restenosis occurred in 6 cases within 4 months after PTA. In 2 cases, small thalamic infarction occurred30 minutesand 3 hoursafter uneventful procedure of PTA, respectively. Finally surgical reconstructions were performed in 10 of 52 PTA cases for unsuccessful PTA (5 cases), poor dilation (2 cases), and restenosis (2 cases). For reconstruction of VA stenosis at the origin, PTAappears to be a simple, less invasive, and effective method. But we would pay attention to restenosis after PTAand embolism dUring and after PTA. When PTAseemsto be difficult or has turned out unsuccessful. we had betterto select surgery insteadof PTA. We should be familiar not only with PTA but also wilh surgery to achieve good resultsand avoid surgicalcomplications.
Monday, 7 luly 1997
IP-1- 1241 hyperperfusion Low perfusion reserve predicts cerebral induced by surgical revascularization Tetsuyuki Yoshimoto, Kiyohiro Houkin, HiroshiAbe. Departmentof Neurosurgery, Hokkaido University, School of Medicine, Sapporo, Jspsn Introduction: Hyperperfusion syndrome after surgical revascularization is a rare complication. There has been no systematic study on factors thaI predict the hyperperfusion after revascularization surgery. In this paper, retrospective analysis of the factors related to the post-operative hyperperfusion will be investigated. Patients and Methods: 46 cases of surgical revascularization including 33 casesof carotid endanerectomy (CEA)and 13casesof STA-MCA anastomosis are analyzed. Among lhese, there were 3 cases 01 post-operative hyperperfusian syndrome despile at well-controlled blood pressurepost-operatively. Four factors, that is 1) regional cerebral blood flow (rCBF). 2) the increase in the ratio of the post-operative rCBF. 3) cerebral perfusion reserve as shown by the increase of rCBF after acetazolamide administration (to.rCBF) and 4) the difference in meanblood pressure between the preoperative and postoperative stale (to.BP), were analyzed, Results: Preoperative rCBF was signilicanlly lower in cases of hyperperfusionsyndrome thanthecontrolcases(p < 0.01). Moreoverto.rCBF was lower in hyperperfusion cases (p < 0.05). However. there were no apparentdifferences in increase of rCBFand to.BP between the hyperperfusion casesand the control cases. Conclusion: Incasesof marked lowperfusion (lowrCBF)withpoorperfusion reserve, hyperperfusian can take place even if blood pressure is adequately controlled.
IP-1-12S ! Neurosurgical management of cerebellar infarction A. Isla. A. Bendala, B. Bejarano, F. Alvarez, M.G. Blazquez. Service of Neurosurgery, Hospital"La Paz", Madrid, Spain A review was made of eight patients with acute cerebellar ischemia on which surgerywas performed. The dinical findings were cephalea, vomiting and impaired level of consciousness. The type of surgery was in four cases external drainage of the ventricle, in one case ventriculo-peritoneal derivation and in threecasesdecompressive SUb-occipital craniotomy(one of these neededventriculo-peritoneal derivation). We appliedthe surgicaltechniques from major to less complexity in relation to the evolution of the clinical pattern. The results were good in 6 cases and fair in 2 patients who had a dependent outcome.
IP.1-126!
CBF, metabolism and neuropsychological function following bypass surgery for hemodynamic ischemia
Kazuyuki Miura, SohichiTaguchi, Masayuki Funayama, NoriyukiKuwata, AkinoriYabuta, Michiyasu Suzuki, Naohiko Kubo, KiyoshiKuroda, Akira Ogawa. Departmentof Neurosurgery, Iwate Medical University, Morioka, Japan We aimed to evaluate superficial temporal artery to proximal middle cerebral artery anastomosis in patients with hemodynamic ischemia in the anterior cireulatlon, Methods: Tenpatientswith internal carotid occlusion, 4 withmiddlecerebral artery occlusion, and 6 with sever stenosis of middle cerebral artery were selected. They showedno marked low density area on CT,with or without minor neurological deficit. We analyzed CBF & metabolism (restingstate and acetazolamide challenge) pre and postoperatively, using positron emission tomography. (CBF[after challenge]-eBF[restJ)/CBF[restJ) was definedas cerebrovascular reserve capacity (CVRC). We also investigated higher cortical function with Hasegawa-dementia scale-revised (HDS-R). mini-mental state examination (MMS), and Wechsler adult intelligence scale-revised (WAIS-R). Results: Postoperatively, significant improvement was observed on CBF[rest] and CVRC. HD5-R and WAIS-R also significantly imprOVed. In patientswith low scoresof HDS-R(below24), high level of preoperative OEF sig· nificantlydecreased postoperatively, corresponding to improvement of HDS-R scores. Preoperative analysisof WAIS-R showed that performance 10 was significantlyaffected in patients with right lesion, andverbal 10was in patientswith left lesion. Conclusion: STA-proximal MCA anastomosis is possible to ameliorate higherbrainfunction through improvement of CBF and metabolism.