Arterial Bypass for the Treatment of Giant and Fusiform Intracranial Aneurysms

摘要

Giant and fusiform intracranial aneurysms that incorporate the parent artery or branch vessels or have a densely atherosclerotic or calcified neck often cannot be clipped safely. Although many patients with these aneurysms can be treated by proximal parent artery occlusion alone, inadequate collateral circulation in some patients mandates the inclusion of an arterial bypass procedure in the therapeutic approach. This review describes indications for arterial bypass when treating giant and fusiform intracranial aneurysms and perioperative management and surgical techniques. The lessons learned from the successful and unsuccessful applications of bypass procedures in 35 patients with anterior or posterior circulation aneurysms are presented. The bypass patency rate for this series was 95% and 29 (83%) of the patients had an excellent or good outcome (3 of the 4 postoperative deaths occurred in patients treated for giant fusiform basi-lar trunk aneurysms).