Revascularization and aneurysm surgery: Current techniques, indications, and outcome

REVASCULARIZATION IS AN important component of treatment for complex aneurysms that cannot be directly clipped and instead require parent vessel occlusion. A consecutive series of 61 patients with 63 aneurysms requiring cerebral revascularization is presented. Aneurysms were located along the petrous internal carotid artery (ICA) (n = 5), the cavernous ICA (n = 16), the supraclinoid ICA (n = 12), the middle cerebral artery (n = 17), the anterior cerebral artery (n = 4), the vertebral artery/posterior inferior cerebellar artery (n = 5), and the midbasilar artery (n = 4). Aneurysms were treated by direct clipping (n = 8), trapping (n = 28), proximal vessel occlusion (n = 9), distal vessel occlusion (n = 1), excision (n = 15), and thrombotic occlusion (n = 2). Revascularization was performed with petrous to supraclinoid ICA bypass (n = 12), superficial temporal artery to middle cerebral artery bypass (n = 15), superficial temporal artery to middle cerebral artery bypass with saphenous graft (n = 5), superficial temporal artery to superior cerebellar artery bypass (n = 4), long saphenous bypass (n = 11), in situ bypass (n = 3), and primary reanastomosis (n = 13). Fifty-seven patients (93%) had good outcomes, and one patient died (surgical mortality, 2%). This experience demonstrates that revascularization can be performed with low morbidity and mortality. We think that the cumulative risks of not performing revascularization in patients who tolerate ICA balloon occlusion exceed the surgical risk of revascularization. We therefore favor revascularization in patients with complex aneurysms treated by surgical arterial occlusion.