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Bypassy naczyń mózgowych –
podstawy anatomiczne
Anna Pruszyńska
Jak przywrócić przepływ w mózgu?
Pośrednio:
-Stymulacja rozrostu kapilar
-Wymaga czasu
-Przepływ trwale ograniczony
-Zaburzenie autoregulacji przepływu
Bezpośrednio:
-połączenie naczyń
-pełne i natychmiastowe przywrócenie
przepływu
Bezpośrednie przywrócenie
przepływu
Bypass niskoprzepływowy
- <50 ml/min
- Bez utraty (fragmentu)
naczynia
- Uzupełnienie przepływu
- Mały obszar
Bypass
wysokoprzepływowy
1. Przeszczep t.
promieniowej
- 50-150 ml/min
2. Przeszczep ż.
Odpiszczelowej
- 100 – 250 ml/min
• Utrata naczynia
• Całkowite zastąpienie
przepływu
• Duży obszar
MA-MCA
• Kraniotomia w dole podskroniowym
• Połączenie t. szczękowej z t.
środkową mózgu za pomocą
przeszczepu
STA-MCA
Warianty:
- Połączenie rozdwojone
- Połączenie przez przeszcz
żylny
EC –MC/EC - IC
Wskazanie: duże ograniczenie
przepływu dające objawy
neurologiczne!
Przeszczep z tętnicy
promieniowej lub żyły
odpiszczelowej.
IC - IC
Naczynie dawcze:
- Część skalista ICA
- Część szyjna ICA
Naczyniem biorczym jest z
reguły ICA nad wyrostkiem
pochyłym.
VA - MCA
Przeszczep „czepkowy”
Jest to połączenie między MCA a przeciwległą
STA.
Naczyniem łączącym jest najczęściej t.
promieniowa.
Połączenie naczyń
1. Metoda ręczna – zszywanie
2. Metody nie wymagające zamykania naczynia
biorczego
• ELANA
• C-port xA Distal Anastomosis System
ELANA
C-port xA
Zalecenia
• Podawanie heparyny
• Przeszczep nie może być napięty, co groziłoby
skurczem
• Nie wolno wszyć żyły odwrotnie do kierunku
przepływu (zastawki!)
• Przeszczep nie może być skręcony ani zagięty
pod ostrym kątem
Kiedy bypassy?
• Niedokrwienie mózgu
• Choroba Moya-Moya
• Tętniaki, zwłaszcza duże
• Bogato unaczynione guzy podstawy czaszki
• Znaczne zwężenie naczyń mózgowych
(miażdżyca)
Alternatywa?
Dzięki 

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Bypassy naczyń mózgowych – podstawy anatomiczne