title: Indications and Outcomes of Prophylactic and Therapeutic Extracranial-to-intracranial Arterial Bypass for Cerebral Revascularization.
abstract: BACKGROUND
  Extracranial-to-intracranial (EC-IC) arterial bypass is a technically demanding procedure used to treat complex cerebral artery diseases. The indications, proper surgical techniques, and outcomes of this procedure have been under debate over the recent decades.
  
  
  METHODS
  Between January 2004 and December 2012, 28 patients, including patients with cerebral artery occlusion, intracranial aneurysm, cranial base tumor, and Moyamoya disease, underwent EC-IC bypass. Patients' records were retrospectively reviewed for demography, indications, complications, high-flow versus low-flow bypass, patency rate of bypass, and neurological outcome. The patients were sorted into prophylactic (n = 16) and therapeutic (n = 12) groups based on the preoperative presentation of their neurological symptoms. Follow-up evaluation was performed at a mean of 32.7 ± 24.3 months.
  
  
  RESULTS
  The overall patency rate of bypass was 100%, the postoperative stroke rate was zero, and the surgical complication rate was 14.3%. There was no significant difference in the bypass patency rate between the 2 groups or between the high-flow and low-flow bypass patients. Patients who underwent prophylactic bypass had minimal surgical and total complications (P = 0.03 and P < 0.01, respectively) and a better neurological outcome. Surgical complications were more common in patients who underwent therapeutic bypass (25%).
  
  
  CONCLUSIONS
  The collaboration of neurosurgeons and plastic surgeons in performing EC-IC bypass can result in excellent outcomes with a high bypass patency rate and few complications, particularly for prophylactic EC-IC bypass.
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex.
authors.forename: Emre
authors.initials: E
authors.lastname: Gazyakan
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex.
authors.forename: Ching-Yi
authors.initials: CY
authors.lastname: Lee
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex.
authors.forename: Chieh-Tsai
authors.initials: CT
authors.lastname: Wu
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex.
authors.forename: Chung-Kan
authors.initials: CK
authors.lastname: Tsao
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex.
authors.forename: Randall
authors.initials: R
authors.lastname: Craft
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Henry
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex.
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Cheng
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex.
authors.forename: Shih-Tseng
authors.initials: ST
authors.lastname: Lee