ABSTRACT
Most intracranial aneurysms can be managed with either microsurgical clipping or endovascular
coiling. A subset of complex aneurysms with aberrant anatomy or fusiform/dolichoectatic
morphology may require revascularization as part of a strategy that occludes the aneurysm
or parent artery or both. Bypass techniques have been invented to revascularize nearly
every intracranial artery. An aneurysm that will require a saphenous vein bypass is
one that cannot be treated with conventional microsurgical clipping or endovascular
coiling and also requires deliberate sacrifice of a major intracranial artery as part
of the alternative treatment strategy. In the past 7 years the senior author (MTL)
has performed a total of 110 bypasses, of which 46 were for aneurysms. Twenty-two
of these patients received high-flow extracranial-to-intracranial bypasses using saphenous
vein grafts, of which 16 had aneurysms that were giant in size. We review the indications
for saphenous vein bypasses for complex intracranial aneurysms, surgical techniques,
and clinical management strategies.
KEYWORDS
Subarachnoid hemorrhage - intracranial aneurysm - microsurgery - revascularization
- saphenous vein graft - anastomosis
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Michael T LawtonM.D.
Department of Neurological Surgery, University of California, San Francisco
505 Parnassus Ave., Moffitt Hospital Rm. M779
Box 0112, San Francisco, CA 94143-0112
eMail: lawtonm@neurosurg.ucsf.edu
