血管搭桥手术的时代过去了吗（英文）

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1、IstheageoftheCerebralBypassGone?JonathanWhite,M.D.AssociateProfessorofNeurosurgeryUTSouthwesternMedicalCenterDallas,TexasHistoricalIndicationsForBypass:Vascularreplacement:ComplexaneurysmsTumorsIschemiaMoyaMoyadiseaseAtherosclerosisHistoricaluseofbypass?Fukushima1986-2006100pati

2、ents,SaphenousveinAneurysm,Menigioma,carotidbody,glomus,otherThreetypesofbypassPetroustoparaclinoidCervicalexternaltopetrousCervicalexternaltoM2ThingsChangeTraditionalwaysnolongerneeded:BetterTechnology?Tumors:BettermicrosurgeryMicroscopeUltrasonicaspiratorTumors:GammaKnifeAneur

3、ysms?BettermicroscopeBetterclipsIntra-operativeangiographyAnesthesiaBettersurgeons?BettersurgicaltrainingAneurysms:CoilsandStentsWhataboutIschemia?ResultsofBypassStudies:BypassdoesnotworkNEnglJMed.313(19):1191-2000,1985,Nov7.714Medicaland663STA-MCAbypasspatientsFollowed56months

4、NodifferenceoverallbetweengroupsSomesurgicalsubgroupdidworse:MCAstenosis,carotidocclusionwithTIAAngioplastyandStentDoesnewtechnologyandinformationeliminatetheneedfortraditionaltechniques?GammaKnife?GammakniferesultsPoorcontrolwithlargevolumetumorsRiskofvascularinjuryAneurysmCoil

5、ing?UTSouthwestern2002-200695aneurysmsgreaterthen2.0CM17weretreatedbyprimaryendovascularOnly9(53%)completelyoccluded12(71%)requiredre-treatmentIschemicdisease:FlawsofpreviousbypasstrialsPre–operativestrokesconsideredsurgicalfailureSelectionbias–goodsurgicalcandidatesnotrandomiz

6、edMedicalfailurecasesdidnotcrossNotenoughpowertoidentifysubgroupswhichmaybenefitfrombypassIschemia:NeedtomeasureatrisktissueYonas,JNSG1993XeCT;compared5%vs50%dropinflowwithdiamox68patientsfor24months4.4%vs36%strokeriskinlowflowPtsGrubb,JAMA1998PETevidenceofhighoxygenextraction,3

7、1month11/39(28%)vs2/42(5%)ipislateralstrokeriskSTA-MCAbypassforischemia:STA-MCAbypassSTA-MCAbypassSTA-MCAbypassSTA-MCABypassSTA-MCAresultsJapaneseEC-ICBypasstrial(JET)1st206patients,surgerygrouphassignificantlyfewerstrokesStanfordstudyofMoyaMoyapatientsDecreasedfutureriskofstrok

8、eRegressionofMoyaMoyacollateralsCosstrialHighri