Published in: Frontiers in Radiology
Authors: Mathew J. Gallagher; Joseph Frantzias; Ahilan Kailaya-Vasan; Thomas C. Booth; Christos M. Tolias
Year: 2022
Publication details: '2:981501
DOI: 10.3389/fradi.2022.981501
Publication type: Journal article
Topic: Cerebral revascularisation, cerebral bypass, complex aneurysms, flow diversion, moyamoya disease

Simple summary

This publication focuses on brain surgery for deep-seated brain tumours and looks at changes in small blood vessels on the surface of the brain during minimally invasive surgical approaches. It is relevant to intraoperative monitoring, surgical planning and the use of imaging during complex neurosurgical procedures.This study reviews how cerebral revascularisation surgery has changed in the UK as flow-diverting stents have become more widely used for complex aneurysms. It is useful for explaining why complex neurovascular care depends on careful case selection and specialist team experience.

Mr Kailaya-Vasan’s involvement

Mr Kailaya-Vasan, consultant neurosurgeon and neurovascular surgeon, is listed as a contributing author on this publication.

Published abstract

The following abstract is reproduced from the original publication and is provided for reference. It may include technical terminology intended for clinical or academic audiences.

Objective: We describe the chronological trends in cerebral revascularization surgery through a single-surgeon experience; and we review whether in the context of giant and fusiform cerebral aneurysms, flow-diverting stents have impacted on the use of cerebral revascularization surgery. Methods We review our single institution prospectively collected database of cerebral revascularization procedures between 2006 and 2018. Comparing this to our database of flow-diverting endovascular stent procedures, we compare the treatment of fusiform and giant aneurysms. We describe patient demographics, procedural incidence, complications, and outcomes. Results Between 2006 and 2018, 50 cerebral revascularization procedures were performed. The incidence of cerebral revascularization surgery is declining. In the context of giant/fusiform aneurysm treatment, the decline in cerebral revascularization is accompanied by a rise in the use of flow-diverting endovascular stents. Thirty cerebral revascularizations were performed for moyamoya disease and 11 for giant/fusiform aneurysm. Four (14%) direct bypass grafts occluded without neurological sequela. Other morbidity included hydrocephalus (2%), transient ischemic attacks (2%), and ischemic stroke (2%). There was one procedure-related mortality (2%). Flow-diverting stents were inserted for seven fusiform and seven giant aneurysms. Comparing the treatment of giant/fusiform aneurysms, there was no significant difference in morbidity and mortality between cerebral revascularization and flow-diverting endovascular stents. Conclusion We conclude that with the decline in the incidence of cerebral revascularization surgery, there is a need for centralization of services to allow high standards and outcomes to be maintained.

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