Reversão de deficits neurológicos fixos após anastomose arterial extra-intracraniana

Brandt, Reynaldo A.; Settani, Flávio P.

doi:10.1590/S0004-282X1980000200002

Resumos

Quatro pacientes selecionados que apresentaram deficits neurológicos fixos por 3 a 5 semanas conseqüentes a ictos cerebrais completos foram submetidos a anastomose arterial extra-intracraniana. O estudo angiográfico mostrou oclusão da artéria carótida interna em um caso e da artéria cerebral média nos demais. Em todos havia circulação colateral para o território da artéria ocluida. Todos apresentaram recuperação acentuada do déficit neurológico, a partir das primeiras horas após a cirurgia em 3 casos e dos primeiros dias em outro. A presença de circulação colateral para o território de uma artéria cerebral ocluida e responsável por deficits neurológicos fixos pode ser considerada útil na seleção de pacientes para anastomose arterial extra-intracraniana.

Four patients with fixed neurological deficits due to occlusion of the middle cerebral or the internal carotid arteries, and with collateral circulation to their territory diagnosed by angiography, recovered after extra-intracranial arterial anastomosis. Functional recovery was seen since the first hours after bypass in three cases and the first few days in the other. Angiographic demonstration of collateral circulation to the territory of an occluded cerebral artery seems to be useful in the selection of patients with fixed neurological deficits for extra-intracranial arterial anastomosis, mainly when other methods are not available.

Reversão de deficits neurológicos fixos após anastomose arterial extra-intracraniana

Reversal of fixed neurological deficits after extra-intracranial anastomosis: report of four cases

Reynaldo A. Brandt; Flávio P. Settani

Neurocirurgiões. Setor de Neurocirurgia do Hospital dos Servidores Públicos do Estado de São Paulo, Serviço do Dr. João Teixeira Pinto

RESUMO

Quatro pacientes selecionados que apresentaram deficits neurológicos fixos por 3 a 5 semanas conseqüentes a ictos cerebrais completos foram submetidos a anastomose arterial extra-intracraniana. O estudo angiográfico mostrou oclusão da artéria carótida interna em um caso e da artéria cerebral média nos demais. Em todos havia circulação colateral para o território da artéria ocluida. Todos apresentaram recuperação acentuada do déficit neurológico, a partir das primeiras horas após a cirurgia em 3 casos e dos primeiros dias em outro. A presença de circulação colateral para o território de uma artéria cerebral ocluida e responsável por deficits neurológicos fixos pode ser considerada útil na seleção de pacientes para anastomose arterial extra-intracraniana.

SUMMARY

Four patients with fixed neurological deficits due to occlusion of the middle cerebral or the internal carotid arteries, and with collateral circulation to their territory diagnosed by angiography, recovered after extra-intracranial arterial anastomosis. Functional recovery was seen since the first hours after bypass in three cases and the first few days in the other. Angiographic demonstration of collateral circulation to the territory of an occluded cerebral artery seems to be useful in the selection of patients with fixed neurological deficits for extra-intracranial arterial anastomosis, mainly when other methods are not available.

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Full text available only in PDF format.

Trabalho do Setor de Neurocirurgia do Hospital dos Servidores Públicos do Estado de São Paulo, Serviço do Dr. João Teixeira Pinto.

Reynaldo A. Brandt - Pça. Charles Miller 8 - 01234 São Paulo, BP - Brasil.

1. ASTRUP, J.; SYMON, L.; BRANSTON, N. M. & LASSEN, N. A. - Thresholds of cerebral ischemia. In Schmieden, P.; Gratzl, O. & Spetzler, R. - Microsurgery for Stroke, 16, Springer-Verlag, New York, 1977.
2. AUSTIN, G.; HAYWARD, W. & LAFFIN, D. - Modification of cerebral ischemia by microsurgical intracranial anastomosis. In Austin, G. M. - Microsurgical Anastomoses for Cerebral Ischemia. Charles C. Thomas, Springfield (Illinois), 1976.
3. CHATER, N.; WEINSTEIN, P. & SPETZLER, R. - Microvascular bypass for cerebral ischemia: an overview, 1966-1976. In Schmiedek, P.; Gratzl, O. & Spetzler, R. - Microsurgery for Stroke, Springer-Verlag. Nerw York, 1977.
4. CHATER, N. - Patient selection and results of extra to intracranial anastomosis in selected cases of cerebrovascular disease. Clin. Neurosurg. 23:287, 1976.
5. CHATER, N. & POPP, J. - Microsurgical vascular bypass for occlusive cerebrovascular disease: review of 100 cases. Surg. Neurol. 6:115, 1976.
6. DERUTY R.; DUQUESNEL, J.; LECUIRE, J.: DECHAUME, J. P. & BRET, P. - L'anastomose extra-intracranienne: correlations radio-cliniques. Neurochirurgie (Paris) 24:355, 1978.
7. DERUTY, R.; BRET, P.; LECUIRE, J.; LAPRAS, C. & CAPDEVILLE, J. - L'anastomose artérielle extra-intra-cranienne: bilan d'une experience clinique de 40 ans- Neurochirurgie (Paris) 24:355, 1978.
8. GRATZL, O.; SCHMIEDEK, P.; STEINHOFF, H. & EIZENBACH, R. - The significance of regional cerebral blood flow (rCBF) studies for microvascular surgery in patients with cerebral ischemia. In Koos, W. T.; Böck, F. W. & Spetzler, R. F. - Clinical Microneurosurgery, Georg Thieme, Stuttgart, 1976.
9. HEILBRUN, M. P. & ANDERSON, R. E. - Preoperative evaluation of STA-MCA anastomosis candidates with rCBF studies. In Schmiedek, P.; Gratzl, O. & Spetzler, R. - Microsurgery for Stroke, Springer-Verlag, New York, 1977.
10. HOLBACH, K. H.; WASSMANN, H. & BONATELLI, A. P. - A method to identify and treat reversible ischemic alterations of brain tissue. In Schmiedek, P.; Gratzl, O. & Spetzler, R. - Microsurgery for Stroke, Springer-Verlag, New York 1977.
11. HOLBACH, K. H.; WASSMANN, H.; HOHENLUCHTER, K. L. & JAIN, K. K. -Differentiation between reversible and irreversible post-stroke changes in brain tissue: its relevance for cerebrovascular surgery. Surg, Neurol. 7:325, 1977.
12. ITO, Z.; HEN, R.; NAKAJIMA, K.; SUZUKI, A. & UEMURA, K. - Selection of completed stroke patients for STA-MCA anastomosis based on measurements of somatosensory evoked potentials and CBF dynamics. In Schmiedek, P.; Gratzl, O. Spetzler, R. - Microsurgery for Stroke, Springer-Verlag, New York, 1977.
13. PEERLESS, S. J.; CHATER, N. L. & FERGUSON, G. F. - Multiplevessel occlusions in cerebrovascular disease: a further follow-up of the effects of microvascular bypass on the quality of life and the incidence of stroko. In Schmiedek, P.: Gratzl, O. & Spetzler, R. - Microsurgery for Stroke, Springer-Verlag, New York, 1977
14. REICHMAN, O. H. - Neurosurgical microsurgical anastomosis for cerebral ischemia, five years' experience. In Scheinberg, P. - Cerebrovascular Diseases, Raven Press, New York, 1976.
15. ROSKI, R.; SPETZLER, R. F.: OWEN, M.; CHANDER, K.; SHOLL, J. C. & NULSEN, F. E. - Reversal of seven-year old field deffect with extracranial-intracranial arterial anastomosis. Surg. Neurol. 10:267, 1978.
16. SCHMIEDEK, P.; GRATZL, O.; SPETZLER, R.; STEINHOFF, H.; ENZENBACH, R.; BRENDEL, W. & MARGUTH, F. - Selection of patientes for extra-intracranial arterial bypass surgery based on rCBF measurements. J. Neurosurg. 44:303, 1976.
17. SPETZLER, R. F. & CHATER, N. L. - Microvascular arterial bypass in cerebrovascular occlusive disease. In Koos, W. T.; Böck, F. W. & Spetzler, R. F. - Clinical Microneurosurgery, Georg Thieme, Stuttgart, 1976.
18. SPETZLER, R. F. - Extracranial-intracranial arterial anastomosis for cerebrovascular disease. Surg. Neurol. 11:157, 1979.
19. YASARGIL, M. G. - Microsurgery Applied to Neurosurgery, Academic Press, New York, 1969.

Datas de Publicação

Publicação nesta coleção
23 Ago 2012
Data do Fascículo
Jun 1980

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ASTRUP, J.; SYMON, L.; BRANSTON, N. M. & LASSEN, N. A. - Thresholds of cerebral ischemia. In Schmieden, P.; Gratzl, O. & Spetzler, R. - Microsurgery for Stroke, 16, Springer-Verlag, New York, 1977.

[2] 2. AUSTIN, G.; HAYWARD, W. & LAFFIN, D. - Modification of cerebral ischemia by microsurgical intracranial anastomosis. In Austin, G. M. - Microsurgical Anastomoses for Cerebral Ischemia. Charles C. Thomas, Springfield (Illinois), 1976.

[3] 3. CHATER, N.; WEINSTEIN, P. & SPETZLER, R. - Microvascular bypass for cerebral ischemia: an overview, 1966-1976. In Schmiedek, P.; Gratzl, O. & Spetzler, R. - Microsurgery for Stroke, Springer-Verlag. Nerw York, 1977.

[4] 4. CHATER, N. - Patient selection and results of extra to intracranial anastomosis in selected cases of cerebrovascular disease. Clin. Neurosurg. 23:287, 1976.

[5] 5. CHATER, N. & POPP, J. - Microsurgical vascular bypass for occlusive cerebrovascular disease: review of 100 cases. Surg. Neurol. 6:115, 1976.

[6] 6. DERUTY R.; DUQUESNEL, J.; LECUIRE, J.: DECHAUME, J. P. & BRET, P. - L'anastomose extra-intracranienne: correlations radio-cliniques. Neurochirurgie (Paris) 24:355, 1978.

[7] 7. DERUTY, R.; BRET, P.; LECUIRE, J.; LAPRAS, C. & CAPDEVILLE, J. - L'anastomose artérielle extra-intra-cranienne: bilan d'une experience clinique de 40 ans- Neurochirurgie (Paris) 24:355, 1978.

[8] 8. GRATZL, O.; SCHMIEDEK, P.; STEINHOFF, H. & EIZENBACH, R. - The significance of regional cerebral blood flow (rCBF) studies for microvascular surgery in patients with cerebral ischemia. In Koos, W. T.; Böck, F. W. & Spetzler, R. F. - Clinical Microneurosurgery, Georg Thieme, Stuttgart, 1976.

[9] 9. HEILBRUN, M. P. & ANDERSON, R. E. - Preoperative evaluation of STA-MCA anastomosis candidates with rCBF studies. In Schmiedek, P.; Gratzl, O. & Spetzler, R. - Microsurgery for Stroke, Springer-Verlag, New York, 1977.

[10] 10. HOLBACH, K. H.; WASSMANN, H. & BONATELLI, A. P. - A method to identify and treat reversible ischemic alterations of brain tissue. In Schmiedek, P.; Gratzl, O. & Spetzler, R. - Microsurgery for Stroke, Springer-Verlag, New York 1977.

[11] 11. HOLBACH, K. H.; WASSMANN, H.; HOHENLUCHTER, K. L. & JAIN, K. K. -Differentiation between reversible and irreversible post-stroke changes in brain tissue: its relevance for cerebrovascular surgery. Surg, Neurol. 7:325, 1977.

[12] 12. ITO, Z.; HEN, R.; NAKAJIMA, K.; SUZUKI, A. & UEMURA, K. - Selection of completed stroke patients for STA-MCA anastomosis based on measurements of somatosensory evoked potentials and CBF dynamics. In Schmiedek, P.; Gratzl, O. Spetzler, R. - Microsurgery for Stroke, Springer-Verlag, New York, 1977.

[13] 13. PEERLESS, S. J.; CHATER, N. L. & FERGUSON, G. F. - Multiplevessel occlusions in cerebrovascular disease: a further follow-up of the effects of microvascular bypass on the quality of life and the incidence of stroko. In Schmiedek, P.: Gratzl, O. & Spetzler, R. - Microsurgery for Stroke, Springer-Verlag, New York, 1977

[14] 14. REICHMAN, O. H. - Neurosurgical microsurgical anastomosis for cerebral ischemia, five years' experience. In Scheinberg, P. - Cerebrovascular Diseases, Raven Press, New York, 1976.

[15] 15. ROSKI, R.; SPETZLER, R. F.: OWEN, M.; CHANDER, K.; SHOLL, J. C. & NULSEN, F. E. - Reversal of seven-year old field deffect with extracranial-intracranial arterial anastomosis. Surg. Neurol. 10:267, 1978.

[16] 16. SCHMIEDEK, P.; GRATZL, O.; SPETZLER, R.; STEINHOFF, H.; ENZENBACH, R.; BRENDEL, W. & MARGUTH, F. - Selection of patientes for extra-intracranial arterial bypass surgery based on rCBF measurements. J. Neurosurg. 44:303, 1976.

[17] 17. SPETZLER, R. F. & CHATER, N. L. - Microvascular arterial bypass in cerebrovascular occlusive disease. In Koos, W. T.; Böck, F. W. & Spetzler, R. F. - Clinical Microneurosurgery, Georg Thieme, Stuttgart, 1976.

[18] 18. SPETZLER, R. F. - Extracranial-intracranial arterial anastomosis for cerebrovascular disease. Surg. Neurol. 11:157, 1979.

[19] 19. YASARGIL, M. G. - Microsurgery Applied to Neurosurgery, Academic Press, New York, 1969.