Revascularization for complex intracranial aneurysms.

Daniel L. Surdell, Ziad A. Hage, Christopher S. Eddleman, Dhanesh K. Gupta, Bernard R. Bendok, H. Hunt Batjer

Research output: Contribution to journalReview article

43 Scopus citations

Abstract

The modern management of intracranial aneurysms includes both constructive and deconstructive strategies to eliminate the aneurysm from the circulation. Both microsurgical and endovascular techniques are used to achieve this goal. Although most aneurysms can be eliminated from the circulation with simple clip reconstruction and/or coil insertion, some require revascularization techniques to enhance tolerance of temporary arterial occlusion during clipping of the aneurysm neck or to enable proximal occlusion or trapping. In fact, the importance of revascularization techniques has grown because of the need for complex reconstructions when endovascular therapies fail. Moreover, the safety and feasibility of bypass have progressed due to advances in neuroanesthesia, technological innovations, and ~ 5 decades of accumulating wisdom by bypass practitioners. Cerebral revascularization strategies become necessary in select patients who possess challenging vascular aneurysms due to size, shape, location, intramural thrombus, atherosclerotic plaques, aneurysm type (for example, dissecting aneurysms), vessels arising from the dome, or poor collateral vascularization when parent artery or branch occlusion is required. These techniques are used to prevent cerebral ischemia and subsequent clinical sequelae. Bypass techniques should be considered in cases in which balloon test occlusion demonstrates inadequate cerebral blood flow and in which there is a need for Hunterian ligation, trapping, or prolonged temporary occlusion. This review article will focus on decision making in bypass surgery for complex aneurysms. Specifically, the authors will review graft options, the utility of balloon test occlusion in decision making, and bypass strategies for various aneurysm types.

Original languageEnglish (US)
Pages (from-to)E21
JournalNeurosurgical focus
Volume24
Issue number2
DOIs
Publication statusPublished - 2008

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ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Surdell, D. L., Hage, Z. A., Eddleman, C. S., Gupta, D. K., Bendok, B. R., & Batjer, H. H. (2008). Revascularization for complex intracranial aneurysms. Neurosurgical focus, 24(2), E21. https://doi.org/10.3171/FOC.2008.25.2.E21