Cerebral revascularization for difficult skull base tumors: a contemporary series of 18 patients

Abstract

Objective: Cerebral revascularization has been used in treating difficult skull base tumors when the preservation of the involved native arteries is deemed challenging, and the patients are at risk of developing vascular complications. We aimed to evaluate a recent series of patients who needed high flow cerebral bypasses as part of the surgical treatment strategies for their difficult skull base tumors; to assess current indications and the results of such treatments.

Methods: A prospectively collected consecutive series of patients were studied. These patients received high flow cerebral bypasses in conjunction with surgical resections of the skull base tumors during a 9-year period.

Results: A total of 20 high flow bypasses on 18 patients were performed, as part of the treatment plan for skull base tumors. The mean age was 41 years. Four patients had preoperative transient ischemic attack symptoms, three of which had progressed to acute strokes preoperatively. Thirteen patients (72.2%) had gross total resection. There were no acute perioperative stroke or graft occlusions. The mean follow-up was 47 months (2-104 months). One patient developed asymptomatic graft stenosis 8 months after surgery, which was surgically corrected. Fifteen patients had achieved good clinical outcomes (modified Rankin scale, ≤ 2) at the latest follow-up; one patient died postoperatively and two died of their disease.

Conclusions: High flow bypass for cerebral revascularization is a good surgical option for treating certain difficult skull base tumors. High rate of graft patency and low risk of perioperative stroke can be achieved in experienced hands with concurrent high rate of gross total resection of the tumor and good clinical outcome of the patients.

Keywords: Graft patency; High flow bypass; Skull base tumor.