In situ bypass in the management of complex intracranial aneurysms: Technique application in 13 patients

Alfredo Quinones-Hinojosa, Michael T. Lawton

Research output: Contribution to journalReview article

48 Citations (Scopus)

Abstract

OBJECTIVE: Cerebral revascularization is an important part of the treatment of complex intracranial aneurysms that require deliberate occlusion of a parent artery. In situ bypass brings together intracranial donor and recipient arteries that lie parallel and in close proximity to one another rather than using an extracranial donor artery. An experience with in situ bypasses was retrospectively reviewed. METHODS: Thirteen aneurysms were treated with in situ bypasses between 1997 and 2004. During this time, 1071 aneurysms were treated microsurgically and 46 bypasses were performed as part of the aneurysm treatment. RESULTS: Treated aneurysms were located at the middle cerebral artery (MCA) in five patients, posteroinferior cerebellar artery (PICA) in three patients, vertebral artery in three patients, and anterior communicating artery in two patients. Seven aneurysms were fusiform or dolichoectatic, and six aneurysms were saccular. Microsurgical revascularization techniques included side-to-side anastomosis of intracranial arteries in eight patients and aneurysm excision with end-to-end reanastomosis of the parent artery in five patients. In situ bypasses included A3-A3 anterior cerebral artery bypass in two patients, anterior temporal artery-MCA bypass in one patient, MCA-MCA bypass in one patient, and PICA-PICA bypass in four patients. Aneurysm excision with arterial reanastomosis included three MCA aneurysms and two PICA aneurysms. On angiography, all aneurysms were completely obliterated and 12 bypasses were patent. CONCLUSION: In situ bypass is a safe and effective alternative to extracranial-intracranial bypasses and high-flow bypasses using saphenous vein or radial artery grafts. Although in situ bypasses are more demanding technically, they do not require harvesting a donor artery, can be accomplished with one anastomosis, and are less vulnerable to injury or occlusion.

Original languageEnglish (US)
JournalNeurosurgery
Volume57
Issue number1 SUPPL.
DOIs
StatePublished - Jul 2005
Externally publishedYes

Fingerprint

Intracranial Aneurysm
Aneurysm
Arteries
Middle Cerebral Artery
Tissue Donors
Cerebral Revascularization
Anterior Cerebral Artery
Temporal Arteries
Radial Artery
Vertebral Artery
Saphenous Vein
Angiography
Transplants

Keywords

  • Intracranial aneurysm
  • Microsurgery
  • Revascularization
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

In situ bypass in the management of complex intracranial aneurysms : Technique application in 13 patients. / Quinones-Hinojosa, Alfredo; Lawton, Michael T.

In: Neurosurgery, Vol. 57, No. 1 SUPPL., 07.2005.

Research output: Contribution to journalReview article

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abstract = "OBJECTIVE: Cerebral revascularization is an important part of the treatment of complex intracranial aneurysms that require deliberate occlusion of a parent artery. In situ bypass brings together intracranial donor and recipient arteries that lie parallel and in close proximity to one another rather than using an extracranial donor artery. An experience with in situ bypasses was retrospectively reviewed. METHODS: Thirteen aneurysms were treated with in situ bypasses between 1997 and 2004. During this time, 1071 aneurysms were treated microsurgically and 46 bypasses were performed as part of the aneurysm treatment. RESULTS: Treated aneurysms were located at the middle cerebral artery (MCA) in five patients, posteroinferior cerebellar artery (PICA) in three patients, vertebral artery in three patients, and anterior communicating artery in two patients. Seven aneurysms were fusiform or dolichoectatic, and six aneurysms were saccular. Microsurgical revascularization techniques included side-to-side anastomosis of intracranial arteries in eight patients and aneurysm excision with end-to-end reanastomosis of the parent artery in five patients. In situ bypasses included A3-A3 anterior cerebral artery bypass in two patients, anterior temporal artery-MCA bypass in one patient, MCA-MCA bypass in one patient, and PICA-PICA bypass in four patients. Aneurysm excision with arterial reanastomosis included three MCA aneurysms and two PICA aneurysms. On angiography, all aneurysms were completely obliterated and 12 bypasses were patent. CONCLUSION: In situ bypass is a safe and effective alternative to extracranial-intracranial bypasses and high-flow bypasses using saphenous vein or radial artery grafts. Although in situ bypasses are more demanding technically, they do not require harvesting a donor artery, can be accomplished with one anastomosis, and are less vulnerable to injury or occlusion.",
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AB - OBJECTIVE: Cerebral revascularization is an important part of the treatment of complex intracranial aneurysms that require deliberate occlusion of a parent artery. In situ bypass brings together intracranial donor and recipient arteries that lie parallel and in close proximity to one another rather than using an extracranial donor artery. An experience with in situ bypasses was retrospectively reviewed. METHODS: Thirteen aneurysms were treated with in situ bypasses between 1997 and 2004. During this time, 1071 aneurysms were treated microsurgically and 46 bypasses were performed as part of the aneurysm treatment. RESULTS: Treated aneurysms were located at the middle cerebral artery (MCA) in five patients, posteroinferior cerebellar artery (PICA) in three patients, vertebral artery in three patients, and anterior communicating artery in two patients. Seven aneurysms were fusiform or dolichoectatic, and six aneurysms were saccular. Microsurgical revascularization techniques included side-to-side anastomosis of intracranial arteries in eight patients and aneurysm excision with end-to-end reanastomosis of the parent artery in five patients. In situ bypasses included A3-A3 anterior cerebral artery bypass in two patients, anterior temporal artery-MCA bypass in one patient, MCA-MCA bypass in one patient, and PICA-PICA bypass in four patients. Aneurysm excision with arterial reanastomosis included three MCA aneurysms and two PICA aneurysms. On angiography, all aneurysms were completely obliterated and 12 bypasses were patent. CONCLUSION: In situ bypass is a safe and effective alternative to extracranial-intracranial bypasses and high-flow bypasses using saphenous vein or radial artery grafts. Although in situ bypasses are more demanding technically, they do not require harvesting a donor artery, can be accomplished with one anastomosis, and are less vulnerable to injury or occlusion.

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KW - Microsurgery

KW - Revascularization

KW - Subarachnoid hemorrhage

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