颅外颅内旁路手术2013.pptVIP

Schematic diagram depicts the endoscopic SVG harvest. A: The fiberoptic trocar is used to initially locate and dissect the saphenous vein. B: Insufflation is performed with carbon dioxide to create room for further dissection. C: The cautery scissors are used to coagulate and transect tributary veins. D: The vein cradle is used to run the length of the vein before the vein graft removal. Excimer Laser-Assisted Nonocclusive Anastomosis (ELANA) Technique Case 1 ECA-SVG-ICA bifercation bypass for treatment of a giant cavernous ICA aneurysm. The intracranial anastomosis was performed with the aid of ELANA Case 2 Petrous ICA-SVG-MCA bypass for treatment of a previously coiled para-ophthalmic aneurysm. Both anastomsis were performed with the aid of ELANA Skull Base Tumors ● The use of bypass to enable  operations on difficult skull  base tumors is generally  accepted but is not without detractors    颅底肿瘤● 为切除某些复杂的颅底肿瘤，旁 路手术被接受，但并非无反对   Case 1 Recurrent chondrosarcoma. During operation, the intracavernous ICA was ruptured. Emergency radial artery bypass graft was performed from cervical ICA to MCA2. Case 2 47, F Intracavernous and supracavernous meningioma encasing and narrowing the left ICA ECA-RAG-MCA2 and cervical ICA-SVG-MCA2 ● The use of bypass for skull  base tumors has greatly  declined because of use of  radiosurgery for tumor  remnants. However, this technique remains a valuable  tool   ● 因放射外科的应用，旁路手术用 于颅底肿瘤大为减少，但依然是 一有用方法 ● When a major vessel is invaded  or encased by tumors, there are  two controversies: Whether one try to skeletonize  the tumor or whether the vessel should be resected ?  Whether the patient should be revascularized universally or  selectively ?    ● 对重要血管被肿瘤侵犯或包 绕，两点争论： 将肿瘤与血管分开，还 是连同血管一并切除？ 将重要血管切除后，常 规还是选择性施行血运重 建？