Extracranial-Intracranial High-Flow Bypass with Internal Carotid Artery Ligation at Neck for Giant Cavernous Internal Carotid Artery Dissecting Aneurysm in a Teen Girl with Postoperative Unusual Complication of Mono-ocular Blindness: A Case Report

Forhad H. Chowdhury; Sheikh Mohammod Ekramullah; Mohammod Ibrahim Khalil; Mohammod Shamsul Arifin

doi:10.1055/s-0039-1697729

Indian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2019; 08(03): 207-210
DOI: 10.1055/s-0039-1697729

Case Report

Neurological Surgeons' Society of India

Extracranial-Intracranial High-Flow Bypass with Internal Carotid Artery Ligation at Neck for Giant Cavernous Internal Carotid Artery Dissecting Aneurysm in a Teen Girl with Postoperative Unusual Complication of Mono-ocular Blindness: A Case Report

Forhad H. Chowdhury

¹Department of Neurosurgery, National Institute of Neurosciences and Hospital, Shere-e-bangla Nagar, Dhaka, Bangladesh

,

Sheikh Mohammod Ekramullah

¹Department of Neurosurgery, National Institute of Neurosciences and Hospital, Shere-e-bangla Nagar, Dhaka, Bangladesh

,

Mohammod Ibrahim Khalil

¹Department of Neurosurgery, National Institute of Neurosciences and Hospital, Shere-e-bangla Nagar, Dhaka, Bangladesh

,

Mohammod Shamsul Arifin

²Department of Neurosurgery, Bangabandhu Sheikh Muzib Medical University, Dhaka, Bangladesh

› Author Affiliations

Abstract

Extracranial-intracranial (EC-IC) high-flow bypass with internal carotid artery (ICA) ligation at the neck is an important treatment option for giant cavernous ICA dissecting aneurysm. Such treatment may be associated with many complications. We report a case that developed postoperative mono-ocular blindness. So far to our knowledge such complication has not been reported in the literature. A 14-year-old girl presented with recent headache, eye ache, occasional double vision, and occasional right-sided visual impairment. Neurologic examination revealed no abnormality. Computed tomographic (CT) scan of the head showed a large, right parasellar, and mostly hyperdense space-occupying lesion. CT angiogram of the brain showed giant dissecting aneurysm of right-sided cavernous segment ICA. A right-sided external carotid artery–radial artery graft–middle cerebral artery (ECA-RAG-MCA [M2]) high-flow bypass was done with ligation of the right ICA in the neck. Postoperatively, the patient developed complete, mono-ocular, and permanent blindness on right side. Mono-ocular blindness is a serious complication from ophthalmic/central retinal artery thrombosis in high-flow EC-IC bypass with ICA ligation. Strategy is required to find and to set for its prevention.

Keywords

extracranial-intracranial high-flow bypass - giant cavernous internal carotid artery dissecting aneurysm - radial artery graft - mono-ocular blindness

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References

References
1 Biswas A, Samadoni AE, Elbassiouny A, Sobh K, Hegazy A. Extracranial to intracranial by-pass anastomosis: review of our preliminary experience from a low volume center in Egypt. Asian. J Neurosurg 2015; 10 (04) 303-309
2 Amin-Hanjani S, Barker II FG, Charbel FT, Connolly Jr ES, Morcos JJ, Thompson BG. Cerebrovascular Section of the American Association of Neurological Surgeons. Congress of Neurological Surgeons. Extracranial-intracranial bypass for stroke-is this the end of the line or a bump in the road?. Neurosurgery 2012; 71 (03) 557-561
3 Dong Y, Teoh HL, Chan BP. et al. Changes in cerebral hemodynamic and cognitive parameters after external carotid-internal carotid bypass surgery in patients with severe steno-occlusive disease: a pilot study. J Neurol Sci 2012; 322 (1-2) 112-116
4 Fiedler J, Přibáň V, Skoda O, Schenk I, Schenková V, Poláková S. Cognitive outcome after EC-IC bypass surgery in hemodynamic cerebral ischemia. Acta Neurochir (Wien) 2011; 153 (06) 1303-1311, discussion 1311–1312
5 Kalani MY, Zabramski JM, Hu YC, Spetzler RF. Extracranial-intracranial bypass and vessel occlusion for the treatment of unclippable giant middle cerebral artery aneurysms. Neurosurgery 2013; 72 (03) 428-435, discussion 435–436
6 Krylov VV, Nakhabin OIu, Polunina NA. et al. [High-flow extracranial-intracranial (EC-IC) bypass surgery in a patient with giant right cavernous ICA aneurysm] [in Russian]. Zh Vopr Neirokhir Im N N Burdenko 2012; 76 (05) 40-46, discussion 47
7 Sia SF, Morgan MK. High flow extracranial-to-intracranial brain bypass surgery. J Clin Neurosci 2013; 20 (01) 1-5
8 Yasargil MG. Stuttgart: Microsurgery Applied to Neurosurgery. Georg Thieme 1969
9 Matano F, Murai Y, Tateyama K. et al. Perioperative complications of superficial temporal artery to middle cerebral artery bypass for the treatment of complex middle cerebral artery aneurysms. Clin Neurol Neurosurg 2013; 115 (06) 718-724
10 Mohit AA, Sekhar LN, Natarajan SK, Britz GW, Ghodke B. High-flow bypass grafts in the management of complex intracranial aneurysms. Neurosurgery 2007; 60 (02) (Suppl. 01) ONS105-ONS122 discussion ONS122–ONS123
11 Ono H, Inoue T, Tanishima T, Tamura A, Saito I, Saito N. High-flow bypass with radial artery graft followed by internal carotid artery ligation for large or giant aneurysms of cavernous or cervical portion: clinical results and cognitive performance. Neurosurg Rev 2018; 41 (02) 655-665
12 Ramanathan D, Temkin N, Kim LJ, Ghodke B, Sekhar LN. Cerebral bypasses for complex aneurysms and tumors: long-term results and graft management strategies. Neurosurgery 2012; 70 (06) 1442-1457, discussion1457
13 Zhu W, Tian YL, Zhou LF, Song DL, Xu B, Mao Y. Treatment strategies for complex internal carotid artery (ICA) aneurysms: direct ICA sacrifice or combined with extracranial-to-intracranial bypass. World Neurosurg 2011; 75 (3-4) 476-484
14 Sekhar LN, Kalavakonda C. Cerebral revascularization for aneurysms and tumors. Neurosurgery 2002; 50 (02) 321-331
15 Chazono H, Okamoto Y, Matsuzaki Z. et al. Extracranial-intracranial bypass for reconstruction of internal carotid artery in the management of head and neck cancer. Ann Vasc Surg 2003; 17 (03) 260-265
16 Hayreh SS, Zimmerman MB. Fundus changes in central retinal artery occlusion. Retina 2007; 27 (03) 276-289