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Intracranial–intracranial bypass strategies for the treatment of complex intracranial aneurysms: anatomical characteristics and surgical intervention

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Abstract

Objective

The effectiveness of revascularization for complex aneurysms is well-established. This study aimed to describe the technical characteristics and clinical efficacy of intracranial-to-intracranial (IC-IC) bypass for the treatment of complex intracranial aneurysms.

Methods

We retrospectively reviewed all patients with aneurysms who underwent a preplanned combination of surgical or endovascular treatment and IC-IC bypass at our institution between January 2006 and September 2023. IC-IC bypass techniques included four strategies: type A (end-to-end reanastomosis), type B (end-to-side reimplantation), type C (in situ side-to-side anastomosis), and type D (IC-IC bypass with a graft vessel).

Results

During the study period, ten patients with aneurysms each underwent IC-IC bypass surgery. Aneurysms were located in the middle cerebral artery (60.0%), anterior temporal artery (10.0%), anterior cerebral artery (20.0%), and vertebral artery (10.0%). There were three saccular aneurysms (30.0%), two fusiform aneurysms (20.0%), one dissecting aneurysm (10.0%), and four pseudoaneurysms (40.0%). We performed the type A strategy on five patients (50.0%), type B on one (10.0%), type C on one (10.0%), and type D on three (30.0%).

During a mean period of 68.3 months, good clinical outcomes (modified Rankin Scale score, 0–2) were observed in all patients. Follow-up angiography demonstrated complete aneurysmal obliteration in all patients and good bypass patency in nine of ten patients (90.0%).

Conclusion

The treatment of complex aneurysms remains a challenge with conventional surgical or endovascular treatments. IC-IC bypass surgery is a useful technique, associated with favorable clinical outcomes, for treating complex aneurysms.

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Data availability

Data and materials are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

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Funding

This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: H122C1015).

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Authors and Affiliations

  1. Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea

    Sue-Jee Park, Young-Jun Lee, Woong-Beom Kim, You-Sub Kim, Tae-Sun Kim & Sung-Pil Joo

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Contributions

Sue-Jee Park: investigation and data curation, writing—original draft preparation, and writing—reviewing and editing. Sung-Pil Joo: conceptualization, writing—reviewing and editing, and supervision. Young-Jun Lee: investigation and data curation. Woong-Beom, Kim: software. You-Sub Kim: software and validation. Tae-Sun Kim: validation and methodology.

Corresponding author

Correspondence to Sung-Pil Joo.

Ethics declarations

Ethics approval

This study was in accordance with the ethical standards of the Institutional Review Board of our hospital.

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Competing interests

The authors declare no competing interests.

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Comments

A brief summary of the literature on flow-guided surgery would be a suitable accompaniment to this nice description of IC-IC bypass. Quantitative pre-operative flow measurements are important in planning the revascularization strategy and confirming successful intraoperative flow replacement. Although in practice, many surgeons succeed due to patients’ tolerance and adaptability, we have many tools to maximize the success rate of bypass surgery.

Alfred Pokmeng See

Boston, USA

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Park, SJ., Lee, YJ., Kim, WB. et al. Intracranial–intracranial bypass strategies for the treatment of complex intracranial aneurysms: anatomical characteristics and surgical intervention. Acta Neurochir 166, 42 (2024). https://doi.org/10.1007/s00701-024-05945-y

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