Brain Bypass for Potentially Fatal Conditions

Brain bypass surgery was recently performed at the University of Michigan Health System (UMHS, Ann Arbor, USA) on a patient with aneurysms so large they extended from his neck to up inside his head and compressed the nerves responsible for vision. As a result of the surgery, the patient's vision was improved in the eye with remaining vision and the artery was completely replaced. The operation was performed by Dr. Greg Thompson, director of cerebral-vascular surgery at UMHS.

According to Dr. Thompson, brain bypass surgery can be risky. The key is to select the right person for an operation in order to minimize risk in patients who don't need it, and maximize the benefits for those who do need to restore blood flow to the brain. In the case of the patient with the large aneurysms, Dr. Thompson used transplanted sections of the patient's own healthy blood vessels to circumvent those with aneurysms and provide a new route for blood supply to the brain.

Although the procedure was rarely performed in the past, new imaging techniques have given surgeons greater diagnostic tools, allowing them to select patients best suited for the procedure. These include positron emission tomography (PET) and computed tomography (CT) xenon. PET reveals the metabolism of the brain while CT xenon maps the blood flow to the brain. Brain surgery is most commonly used to treat otherwise inoperable brain aneurysms and to prevent stroke in patients who have had transient ischemic attacks. UMHS is one of a few centers in North America being funded by the National Institutes of Health to assess the effectiveness and long-range durability of brain bypass surgery, particularly for preventing stroke in at-risk patients.

"Because this procedure hasn't been done widely using the most recent selection techniques, we don't yet know the durability of the treatment, that is, how well it stands up over time,” says Dr. Thompson. "That's one of the things the trial will look at.”




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