title: Revascularization for complex cerebral aneurysms.
abstract: OBJECTIVE
  Complex cerebral aneurysms may require indirect treatment with revascularization. This manuscript describes various surgical revascularization techniques together with clinical outcomes.
  
  
  METHODS
  Thirty-two consecutive patients with complex cerebral aneurysm were managed from November 2005 to October 2008. Techniques used for revascularization were high-flow bypass, low-flow bypass, branch artery reimplantion, and primary reanastomosis. Physiologic and anatomic monitoring technologies, including electroencephalography, somatosensory evoked potential monitoring, microvascular doppler ultrasonography, and/or indocyanine green videoangiography were used intraoperatively to assess both brain physiology and vascular anatomy. Patient outcome was determined using the Glasgow Outcome Scale at discharge and at a mean of 12 months post operation (range 6-25 months).
  
  
  RESULTS
  Two cervical carotid aneurysms (6%) were resected followed by primary reanastomosis, 21 aneurysms (66%) were trapped following saphenous vein high-flow bypasses, five (16%) were clipped after superficial temporal or occipital artery low-flow bypasses, and four (12%) middle cerebral branch arteries were reimplanted. Of the 32 patients at discharge, 29 (91%) had a Glasgow Outcome Scale of four or five, two (6%) had severe disability, and one (3%) died.
  
  
  CONCLUSIONS
  Cerebral revascularization remains an effective and reliable procedure for treatment of complex cerebral aneurysms. Low morbidity and mortality rates reflect the maturity of patient selection and surgical technique in the management of these lesions.
authors.affiliation: Department of Neurosurgery, General Hospital of Chinese People's Liberation Army, Beijing, China.
authors.forename: Bai-Nan
authors.initials: BN
authors.lastname: Xu
authors.forename: Zheng-Hui
authors.initials: ZH
authors.lastname: Sun
authors.forename: Chen
authors.initials: C
authors.lastname: Wu
authors.forename: Jin-Li
authors.initials: JL
authors.lastname: Jiang
authors.forename: Ding-Biao
authors.initials: DB
authors.lastname: Zhou
authors.forename: Xin-Guang
authors.initials: XG
authors.lastname: Yu
authors.forename: Garnette R
authors.initials: GR
authors.lastname: Sutherland
authors.forename: Bao-Min
authors.initials: BM
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000473:pathology; D002548:Cerebral Revascularization / Q000379:methods*; D004569:Electroencephalography; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000503:physiopathology / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult