New Trends of Surgery for Stroke and its Perioperative Management

178 Pages·2005·4.13 MB·English

by  M. Niemelä

Acta Neurochirurgica
Supplements
Editor: H.-J. Steiger
New Trends of Surgery for Stroke and its
Perioperative Management
Edited by
Y.Yonekawa,Y. Sakurai, E. Keller, and T. Tsukahara
Acta Neurochirurgica
Supplement 94
SpringerWienNewYork
Prof.Dr.YasuhiroYonekawa
PD.Dr.EmanuelaKeller
UniversityHospital,Zurich,Switzerland
Dr.YoshiharuSakurai
DepartmentofNeurosurgery,SendaiNationalHospital,Sendai,Japan
Dr.TetsuyaTsukahara
DepartmentofNeurosurgery,KyotoNationalHospital,Kyoto,Japan
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Preface
In the last years progress has been made in stroke fistulas,cerebralrevascularizationtechniquesandsur-
treatment. In July 2004 specialists in neurosurgery, gery related to the intracranial venous system a com-
neuroradiology, neurology and neurointensive care prehensiveoverviewaboutstrokesurgeryisgivenwith
discussedrecenttrendsatthe2ndSwissJapaneseJoint an interdisciplinary approach. The book should be of
ConferenceonCerebralStrokeSurgeryheldinZurich, interest for all specialists involved in therapy of cere-
Switzerland.Prof.Dr.Y.Yonekawa,ZurichandProf. brovasculardisease.Theeditorsextendtheirgratitude
D. Y. Sakurai, Sendai were the presidents of the con- tothemanycontributorsandtoallthosewhopartici-
ference. New concepts were worked out during the patedintheconference.Publicationoftheproceedings
conferenceandarepublishedinthisvolume.Thebook is partially supported by Research Fund for Cardio-
startswiththetopicintracranialaneurysms,discussing vascular diseases from Japanese Ministry of Health,
microsurgical and endovasculartreatmentmodalities, Labour and Welfare; Assessment of the quality of
as well as new surgical approaches. Further chapters medical care in cardio- and cerebrovascular diseases
deal with the management of unruptured aneurysms andtheprincipalnationalhospitals.
and with subarachnoid hemorrhage. Practical guide-
linesforvasospasmtreatmentaregiven.Togetherwith Y.Yonekawa,Y.Sakurai,E.Keller,andT.Tsukahara
contributionsaboutarteriovenousmalformationsand
Contents
Intracranialaneurysms
Niemela¨,M.,Koivisto,T.,Kivipelto,L.,Ishii,K.,Rinne,J.,Ronkainen,A.,Kivisaari,R.,Shen,H.,
Karatas,A.,Lehecka,M.,Fro¨sen,J.,Piippo,A.,Ja¨a¨skela¨inen,J.,Hernesniemi,J.:
MicrosurgicalclippingofcerebralaneurysmsaftertheISATStudy........................................ 3
Sugiu,K.,Tokunaga,K.,Watanabe,K.,Sasahara,W.,Tagawa,M.,Tamesa,N.,Ono,S.,Onoda,K.,
Date,I.:
Endovasculartreatmentforelderlypatientswithrupturedaneurysm ...................................... 7
Kaku,Y.:
Conventionalmicrosurgicaltechniqueandtheendovascularmethodforthetreatmentofcerebral
aneurysms:acomparativeview............................................................................. 11
Hernesniemi,J.,Ishii,K.,Niemela¨,M.,Smrcka,M.,Kivipelto,L.,Fujiki,M.,Shen,H.:
Lateralsupraorbitalapproachasanalternativetotheclassicalpterionalapproach........................ 17
Kahn,N.,Yoshimura,S.,Roth,P.,Cesnulis,E.,Koenue-Leblebicioglu,D.,Curcic,M.,Imhof,H.-G.,
Yonekawa,Y.:
Conventionalmicrosurgicaltreatmentofparaclinoidaneurysms:stateoftheartwiththeuseofthe
selectiveextraduralanteriorclinoidectomySEAC.......................................................... 23
Hernesniemi,J.,Ishii,K.,Niemela¨,M.,Krivipelto,L.,Fujiki,M.,Shen,H.:
Subtemporalapproachtobasilarbifurcationaneurysms:advancedtechniqueandclinicalexperience..... 31
Yonekawa,Y.,Khan,N.,Imhof,H.-G.,Roth,P.:
Basilarbifurcationaneurysms.Lessonslearntfrom40consecutivecases .................................. 39
Perioperativemanagement
Schuknecht,B.:
Endovasculartreatmentofcerebralvasospasmfollowinganeurysmalsubarachnoidhemorrhage......... 47
Semenyutin,V.B.,Aliev,V.A.,Nikitin,P.I.,Kozlov,A.V.:
TheintracranialB-waves’amplitudeasprognosticationcriterionofneurologiccomplicationsin
neuroendovascularinterventions............................................................................ 53
Satoh,A.,Nakamura,H.,Kobayashi,S.,Miyata,A.,Matsutani,M.:
Managementofseveresubarachnoidhemorrhage;significanceofassessmentofbothneurologicaland
systemicinsultsatacutestage............................................................................... 59
VIII Contents
Keller,E.,Krayenbu¨hl,N.,Bjeljac,M.,Yonekawa,Y.:
Cerebralvasospasm:resultsofastructuredmultimodaltreatment......................................... 65
Managementofunrupturedintracranialaneurysms
Tsukahara,T.,Murakami,N.,Sakurai,Y.,Yonekura,M.,Takahashi,T.,Inoue,T.,Yonekawa,Y.:
Treatmentofunrupturedcerebralaneurysms;amulti-centerstudyatJapanesenationalhospitals ........ 77
Terada,T.,Tsuura,M.,Matsumoto,H.,Masuo,O.,Tsumoto,T.,Yamaga,H.,Itakura,T.:
Endovasculartreatmentofunrupturedcerebralaneurysms................................................. 87
Imhof,H.-G.,Yonekawa,Y.:
Managementofrupturedaneurysmscombinedwithcoexistinganeurysms ................................ 93
Suyama,K.,Kaminogo,M.,Yonekura,M.,Baba,H.,Nagata,I.:
Surgicaltreatmentofunrupturedcerebralaneurysmsintheelderly........................................ 97
IntracranialarteriovenousmalformationsandDuralAVM,AVF
Yonekawa,Y.,Imhof,H.-G.,Bjeljac,M.,Curcic,M.,Khan,N.:
ThreecasesofAVMateloquentareasfinallytreatedwithconventionalmicrosurgicalmethod............ 105
Kuhmonen,J.,Piippo,A.,Va¨a¨rt,K.,Karatas,A.,Ishii,K.,Winkler,P.,Niemela¨,M.,Porras,M.,
Hernesniemi,J.:
Earlysurgeryforrupturedcerebralarteriovenousmalformations.......................................... 111
Steiger,H.-J.,Ha¨nggi,D.,Schmid-Elsaesser,R.:
Cranialandspinalduralarteriovenousmalformationsandfistulas:anupdate............................. 115
Kuwayama,N.,Kubo,M.,Tsumura,K.,Yamamoto,H.,Endo,S.:
Hemodynamicstatusandtreatmentofaggressiveduralarteriovenousfistulas............................. 123
Cerebralrevascularization
Carotid-andvertebral-stenosis
Barth,A.:
Conventionalmicrosurgicalendarterectomy................................................................ 129
Tsukahara,T.,Hatano,T.,Ogino,E.,Aoyama,T.,Nakakuki,T.,Murakami,M.:
Surgicaltreatmentforbilateralcarotidarterialstenosis .................................................... 133
Hatano,T.,Tsukahara,T.,Ogino,E.,Aoyama,T.,Nakakuki,T.,Murakami,M.:
Stentingforvertebrobasilararterystenosis ................................................................. 137
Extracranial-intracranialbypass
Streefkerk,H.J.,Bremmer,J.P.,Tulleken,C.A.:
TheELANAtechnique:highflowrevascularizationofthebrain........................................... 143
Khan,N.,Yonekawa,Y.:
MoyamoyaangiopathyinEurope .......................................................................... 149
Contents IX
Reinert,M.,Brekenfeld,C.,Taussky,P.,Andres,R.,Barth,A.,Seiler,R.W.:
Cerebralrevascularizationmodelinaswine................................................................ 153
Inoue,T.,Fujimoto,S.:
Predictionofcerebralbloodflowrestorationafterextracranial-intracranialbypasssurgeryusing
superficialtemporalarteryduplexultrasonography(STDU)............................................... 159
Venoussystem
Sindou,M.,Auque,J.,Jouanneau,E.:
Neurosurgeryandtheintracranialvenoussystem .......................................................... 167
Keller,E.,Pangalu,A.,Fandino,J.,Ko¨nu¨,D.,Yonekawa,Y.:
Decompressivecraniectomyinseverecerebralvenousandduralsinusthrombosis......................... 177
Authorindex................................................................................................ 185
Indexofkeywords .......................................................................................... 187
ListedinCurrentContents
Intracranial aneurysms
ActaNeurochir(2005)[Suppl]94:3–6
6Springer-Verlag2005
PrintedinAustria
Microsurgical clipping of cerebral aneurysms after the ISAT Study
M.Niemela¨1,T.Koivisto2,L.Kivipelto1,K.Ishii1,J.Rinne2,A.Ronkainen2,R.Kivisaari1,H.Shen1,
A.Karatas1,M.Lehecka1,J.Fro¨sen1,A.Piippo1,J.Ja¨a¨skela¨inen2,andJ.Hernesniemi1
1DepartmentofNeurosurgery,UniversityHospitalHelsinki,Helsinki,Finland
2DepartmentofNeurosurgery,UniversityHospitalKuopio,Kuopio,Finland
‘‘The arduous work of countless researchers has al- percentages of management morbidity and mortality
readythrownmuchdarknessonthesubject,andifthey – how about the patients who die of acute rebleeding
continue,weshallsoonknownothingatallaboutit’’ [7] or haematoma and do not get a chance of decent
MarkTwain recovery?
TheISATStudynailslowcaseloadmicrosurgeryof KuopioandHelsinkiAneurysmRegistries
cerebralaneurysms
Aneurysmal SAH is particularly frequent in Fin-
This landmark study [9] – somewhat Twainian at land. There is a linkage to 19q13.3 in Finnish aneur-
first glance – sets the stage for future microsurgery in ysm families [17, 20] but the interplay of genetic and
cerebral aneurysms and SAH. The ISAT Study does acquired risks [10] remains to be solved. The Kuopio
not nail microsurgery – it will nail microsurgery in low andHelsinkiAneurysm Registries(a)supportclinical
case load neurosurgical centers and in inexperienced trials [12, 13, 19], (b) collect basic clinical data [5, 6,
hands. In future neurovascular centers, exovascular 16], (c) characterize aneurysm families and collect
andendovascularsurgeonsareforcedtosupporteach bloodsamples[17,20],and(d)collectaneurysmwalls
otherbyhavingthefullresponsibilityoverthepopula- resected after clipping of the neck [4]. The first pub-
tion in a defined geographical area. Exosurgeons will lished prospective randomised study – well before
becomefarmoreexperienced–lessinnumberbutnot ISAT – compared the outcome with acutely ruptured
thelastMohicans. aneurysmaftercoilingorclippingattheKuopioUni-
versityHospitalineasternFinlandin1995–1997[11–
13,19,21].Ofthe199patients(a75years,a72hours
Populationbasedtreatmentofcerebralaneurysmsand from bleeding), only 109 (55%) were randomizable
SAH either to endovascular occlusion or to exovascular
occlusion– e.g., 37 patients were excluded because of
Inthenationalhealthministries,itiswisetoremem-
haematoma or mass e¤ect, and 33 because of aneur-
ber when deciding on the guidelines and facilities for
ysm morphology unsuitable for endovascular occlu-
endosurgery and exosurgery that aneurysmal SAH is
sion[11].
adismallydeadlydiseasewhentreatedwithfullpopu-
lation responsibility. One third of patients present
with a large haematoma or severe hydrocephalus ne-
Cellularandmolecularbiologyofthecerebral
cessitating immediate surgery. Mortality and morbid-
aneurysmwallispoorlyknown
ity figures are unattractive when the treatment center
functions as primary imaging center and accepts all Saccularcerebralarteryaneurysmsarenotjustpres-
patientsatultraearlyphasetopreventrebleeding.Se- surized blebs that threaten to leak. The cellular and
lection and delayed aneurysm occlusion ensure low molecularbiologyoftheaneurysmwallispoorlyunder-