Giant and complex aneurysms treatment with preservation of flow via bypass technique

• Published in: Neuro-chirurgie Vol. 62; no. 1; pp. 1 - 13
• Main Authors: Thines, L, Proust, F, Marinho, P, Durand, A, van der Zwan, A, Regli, L, Lejeune, J.-P
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.02.2016
• Subjects: Anastomosis, Surgical - methods; Anévrisme géant intracrânien; Cerebral Revascularization - methods; Clippage; Clipping; Conventional bypass; Diversion de flux; ELANA; Extracranial-intracranial bypass; Flow diversion; Giant intracranial aneurysm; Humans; Intracranial Aneurysm - surgery; Intracranial-intracranial bypass; Microsurgery - methods; Neurosurgery; Neurosurgical Procedures - methods; Nonocclusive bypass; Pontage conventionnel; Pontage extracrânien-intracrânien; Pontage intracrânien-intracrânien; Pontage non occlusif; Pontage radial; Pontage saphène; Radial artery bypass; Saphenous vein bypass; Stent; Stenting; Surgery; Treatment Outcome; basilar artery; STA; Pontage saphène; Anévrisme géant intracrânien; HFB; Excimer laser-assisted nonocclusive anastomosis; LFB; Stent; IC-IC; common carotid artery; Giant intracranial aneurysm; Pontage intracrânien-intracrânien; low-flow bypass; cerebro-spinal fluid; DSA; Flow diversion; Pontage conventionnel; occipital artery; GIA; subsequent segments of the anterior cerebral artery; Nonocclusive bypass; Saphenous vein bypass; EEG; initial segment of the posterior cerebral artery; PcomA; Stenting; high-flow bypass; VA; electroencephalogram; middle cerebral artery; PCA; Diversion de flux; PICA; Glasgow outcome scale; anterior communicating artery; Conventional bypass; BTO; MRA; external carotid artery; Intracranial-intracranial bypass; A1A2; BA; extracranial-intracranial; computerized tomography angiography; ELANA; EC-IC; magnetic resonance imaging; posterior communicating artery; IFB; MRI; balloon test occlusion; contrast-enhanced transcranial Doppler; Extracranial-intracranial bypass; M1, M2, M3, M4; OA; MEP, SEP; CSF; Pontage radial; internal carotid artery; intermediate-flow bypass; posterior-inferior cerebellar artery; Pontage extracrânien-intracrânien; Radial artery bypass; ACA; CCA; P1; ECA; AcomA; Clippage; vertebral artery; ICA; posterior cerebral artery; digital subtraction angiography; superficial temporal artery; GOS; MCA; CTA; subsequent segments of the middle cerebral artery; Clipping; Pontage non occlusif; CE-TCD; positron emission tomography; intracranial-intracranial; motor and somatosensory-evoked potentials; magnetic resonance angiography; anterior cerebral artery; PET
• ISSN: 0028-3770; 1773-0619
• DOI: 10.1016/j.neuchi.2015.03.008

Abstract Due to their anatomical characteristics and the complexity of the procedures required to obtain their complete occlusion, the treatment of giant intracranial aneurysms is a real challenge. Direct reconstructive strategies, whether by interventional neuroradiology (coils, stents) or microsurgical (clipping) means, are not always applicable and, in patients that would not tolerate parent or collateral artery sacrifice, the adjunction of a revascularization procedure using a bypass technique might be necessary. Cerebral arterial bypasses can be classified according to their function (3 types: flow replacement, flow reversal or protective), the branching mode of the graft used (3 types: pedicled, interpositional or in situ), the sites of anastomosis (2 types: extracranial-intracranial or intracranial-intracranial) and the class of flow they are supposed to provide (3 types: low-, intermediate- or high-flow). In this article, the authors review the different aspects in the management of patients with a giant intracranial aneurysm using a bypass: preoperative work-up, types of bypass and indications, surgical techniques and results.