Extracranial to intracranial (EC-IC) bypass is a surgical procedure in Singapore that aims to increase blood flow to the brain (cerebral circulation). Restricted or limited blood flow can result in tissue death in the brain, also known as perioperative cerebral ischaemia or infarction. The primary objective of an EC-IC bypass is to revive blood supply and is often conducted as a preventative measure for strokes. Cerebral bypass surgery is a procedure reserved for patients with blocked, narrowed, or damaged arteries restricting blood flow to their brain.
An EC-IC bypass is akin to cardiac bypass surgery, which bypasses clogged heart arteries to increase blood and oxygen supply to the heart. Dr Chou is a prominent figure in the EC-IC bypass sphere as he has trailblazed and reignited the practice of this procedure, particularly for critical cerebral ischaemia in Singapore.
An EC-IC bypass is an intricate and complex procedure. It lasts between 3-5 hours and is conducted under general anaesthesia. The surgery, in short, involves connecting blood vessels from outside the brain (extracranial) to a vessel inside the brain (intracranial) to redirect blood flow around the identified blockage.
The procedure first involves a craniotomy, which is conducted to reveal the exact location of the blockage. The next phase involves surgically combining two separate veins via a process known as anastomosis.
The most common EC-IC bypass procedure utilises a superficial temporal artery (STA) to middle cerebral artery (MCA) bypass technique. In some instances, a carotid artery to MCA bypass may be conducted using a radial artery or saphenous vein graft. Where a vein graft is necessary, the vein is usually harvested from the leg. Finally, the surgical site is closed using metal plates and screws.
An EC-IC bypass can be used to treat the following conditions:
EC-IC bypass has brought relief to many patients with an improved quality of life. Under regimented after-care and good lifestyle practices, patients have been empowered with the reduced manifestation of symptoms such as speech impediments and cognitive performance.
Upon EC-IC bypass procedure, it is common for patients to deal with headache symptoms. This, however, is relatively normal as your body adjusts to the procedure and regains neurological functions. Headaches will also resolve and improve gradually within weeks. Neurological tests will be conducted frequently to note improvement in general and neurological function.
EC-IC bypass is a one-off procedure; however, the treatment does not end with surgery. You will be transported to a ward for observation, followed by a series of neurological exams. After the surgery, you may also be assigned a physical therapist to regain mobility.
After your discharge from the hospital (1-4 days) post-surgery, you will be requested to visit our clinic within a week or two for a follow-up. You will also be asked to visit us for a routine check-up to monitor your general well-being.
Recovery can take 2-6 weeks before patients can return to their pre-surgery routine. The recovery period mostly depends on the severity of your condition. An expected timeline will be briefed before surgery to allow you to make the necessary arrangements.
The general success rate for EC-IC bypass treatment is 97%. However, this would vary depending on the underlying health condition, patient age, and severity of their condition.
