Surgical Bypass for Intracranial Aneurysms: Navigating Around a Changing Paradigm

Abstract

p f c n t d t n n T he treatment of giant and complex aneurysms often involves redirection of flow and removal of the aneurysm from circulation. In their study, Zhu et al. review their xperience with complex internal carotid aneurysms and reorted outcomes for patients treated with parent vessel occluion (PVO) alone or with intracranial bypass. Zhu et al. retrospecively reviewed their experience in treating 49 patients with omplex aneurysms over a 7-year period. The investigators used n institutionally standardized protocol of balloon-test occlusion BTO) with computed tomographic perfusion to evaluate the eed for extracranial-intracranial bypass before deconstructive arent vessel occlusion (PVO). With a follow-up range of 5 to 12 onths, 10 patients “passed” BTO and underwent direct interal carotid artery (ICA) sacrifice with no ischemic-related compliations; 39 patients underwent bypass after “failing” BTO, with follow-up range of 3 to 64 months. Graft patency was high 90.7% of all bypasses). In the bypass group, complications ncluded 5 occurrences of minor hemispheric ischemia, from hich all but 1 recovered, 1 intracranial hematoma requiring vacuation, and 4 episodes of graft occlusion. Overall Glasgow utcome Scale values were high; 74% achieved a score of 5 at ast follow-up.