Controversies and Advances in Adult Intracranial Bypass Surgery in 2020. Issue 1 (7th September 2020)

• Record Type: Journal Article
• Authors: Raper, Daniel M S; Rutledge, W Caleb; Winkler, Ethan A; Meisel, Karl; Callen, Andrew L; Cooke, Daniel L; Abla, Adib A
• Is Part Of: Operative neurosurgery. Volume 20:Issue 1(2021)
• Page Start: 1
• Page End: 7
• Publication Date: 2020-09-07
• Subjects: Aneurysm -- Bypass surgery -- Cerebrovascular disease -- Extracranial-intracranial anastomosis -- Intracranial atherosclerotic disease -- Moyamoya disease; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1093/ons/opaa276
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract: Cerebral revascularization utilizing a variety of bypass techniques can provide either flow augmentation or flow replacement in the treatment of a range of intracranial pathologies, including moyamoya disease, intracranial atherosclerotic disease, and complex aneurysms that are not amenable to endovascular or simple surgical techniques. Though once routine, the publication of high-quality prospective evidence, along with the development of flow-diverting stents, has limited the indications for extracranial-to-intracranial (EC-IC) bypass. Nevertheless, advances in imaging, assessment of cerebral hemodynamics, and surgical technique have changed the risk-benefit calculus for EC-IC bypass. New variations of revascularization surgery involving multiple anastomoses, flow preserving solutions, IC-IC constructs, and posterior circulation bypasses have been pioneered for otherwise difficult to treat pathology including giant aneurysms, dolichoectasia, and medically refractory intracranial atherosclerosis. This review provides a practical update on recent advances in adult intracranial bypass surgery.