Revascularization for complex intracranial aneurysms.

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

Research output: Contribution to journalArticle

42 Citations (Scopus)

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)
JournalNeurosurgical Focus
Volume24
Issue number2
StatePublished - 2008
Externally publishedYes

Fingerprint

Intracranial Aneurysm
Aneurysm
Balloon Occlusion
Cerebrovascular Circulation
Decision Making
Cerebral Revascularization
Inventions
Dissecting Aneurysm
Endovascular Procedures
Atherosclerotic Plaques
Brain Ischemia
Surgical Instruments
Ligation
Blood Vessels
Thrombosis
Arteries
Transplants
Safety

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Surdell, D. L., Hage, Z. A., Eddleman, C. S., Gupta, D. K., Bendok, B., & Batjer, H. H. (2008). Revascularization for complex intracranial aneurysms. Neurosurgical Focus, 24(2).

Revascularization for complex intracranial aneurysms. / Surdell, Daniel L.; Hage, Ziad A.; Eddleman, Christopher S.; Gupta, Dhanesh K.; Bendok, Bernard; Batjer, H. Hunt.

In: Neurosurgical Focus, Vol. 24, No. 2, 2008.

Research output: Contribution to journalArticle

Surdell, DL, Hage, ZA, Eddleman, CS, Gupta, DK, Bendok, B & Batjer, HH 2008, 'Revascularization for complex intracranial aneurysms.', Neurosurgical Focus, vol. 24, no. 2.
Surdell DL, Hage ZA, Eddleman CS, Gupta DK, Bendok B, Batjer HH. Revascularization for complex intracranial aneurysms. Neurosurgical Focus. 2008;24(2).
Surdell, Daniel L. ; Hage, Ziad A. ; Eddleman, Christopher S. ; Gupta, Dhanesh K. ; Bendok, Bernard ; Batjer, H. Hunt. / Revascularization for complex intracranial aneurysms. In: Neurosurgical Focus. 2008 ; Vol. 24, No. 2.
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