Revascularization treatment for complex intracranial aneurysms

Objective To investigate the role of revascularization in the treatment of complex intracranial aneurysms. Methods From January 2014 to March 2019, a total of 22 patients with complex intracranial aneurysms were treated with extracranial-intracranial (14 cases) or intracranial-intracranial (8 cases) revascularization at Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine. The treatment methods of intracranial aneurysm included intraoperative isolation, proximal ligation, distal ligation, plastic clamping, encapsulation, intravascular embolism and postoperative embolism. The patency of anastomotic vessels, obliteration of the aneurysms and postoperative complications were observed after operation. Outcomes of patients were evaluated with Glasgow Outcome Scale (GOS). Results In this series, 22 cases successfully underwent revascularization. Intraoperative fluorescein angiography or DSA revealed the patency of anastomotic vessels. Postoperative angiographies were performed and patency of anastomotic vessels was confirmed in 18 patients (81.8%) and obliteration of aneurysms was confirmed in 20 patients (90.9%). Five patients (22.7%) developed various degrees of cerebral infarction. One patient was discharged because of poor prognosis and lost to follow-up. The other 21 patients were followed up for 1-59 months. No aneurysm recurred or ruptured during the follow-up period. GOS was Ⅴ in 20 cases and Ⅳ in 1 case. Conclusion With the proper selection of individualized revascularization based on the characters of aneurysms and cerebral blood flow requirement, revascularization seems an effective and safe method for the treatment of complex intracranial aneurysms. Key words: Intracranial aneurysm; Cerebral revascularization; Treatment outcome