Bypass Surgery for Complex and Giant Intracranial Aneurysms

Since the advent of many high-technology devices in endovascular therapy for cerebrovascular diseases, the role of microsurgical clipping of intracranial aneurysm is gradually being replaced by endovascular means. For instance, a wide neck aneurysm was considered as not a good candidate for coiling; however, with the combination of a coiling and stenting technique this problem can easily be solved today.

No matter what the development of endovascular therapy can achieve, in certain circumstances endovascular treatment still cannot replace microsurgery in the treatment of intracranial aneurysm. For example, the high occurrence rate of compaction phenomenon after coiling makes microsurgical clipping the treatment of choice for giant aneurysm. In some giant aneurysm with the complexity of its configuration or its surrounding anatomy, neither clipping nor coiling modality can accomplish a satisfactory treatment. In that case, various bypass procedures with trapping of the aneurysm may be needed as the ultimate method of treatment.

In our institution we have treated various complex intracranial aneurysms with trapping and various vascular anastomosis procedures including superficial temporal artery to intracranial artery bypass, high-flow graft bypass, interpositional bypass, and reimplantation of the arterial branch to the parent artery. Our results will be analyzed and presented.

In conclusion, microvascular anastomosis technique as neglected by the majority of neurosurgeons will be a pertinent skill for microvascular neurosurgeons in the treatment of intracranial aneurysm in the future. The training of young vascular neurosurgeons to master this technique will be very important.