title: Giant and complex aneurysms treatment with preservation of flow via bypass technique.
abstract: Due to their anatomical characteristics and the complexity of the procedures required to obtain their complete occlusion, the treatment of giant intracranial aneurysms is a real challenge. Direct reconstructive strategies, whether by interventional neuroradiology (coils, stents) or microsurgical (clipping) means, are not always applicable and, in patients that would not tolerate parent or collateral artery sacrifice, the adjunction of a revascularization procedure using a bypass technique might be necessary. Cerebral arterial bypasses can be classified according to their function (3 types: flow replacement, flow reversal or protective), the branching mode of the graft used (3 types: pedicled, interpositional or in situ), the sites of anastomosis (2 types: extracranial-intracranial or intracranial-intracranial) and the class of flow they are supposed to provide (3 types: low-, intermediate- or high-flow). In this article, the authors review the different aspects in the management of patients with a giant intracranial aneurysm using a bypass: preoperative work-up, types of bypass and indications, surgical techniques and results.
authors.affiliation: Clinique de neurochirurgie, Pôle des neurosciences et appareil locomoteur, CHRU de Lille, Université Lille Nord de France, 59000 Lille, France. Electronic address: laurent.thines@wanadoo.fr.
authors.forename: L
authors.initials: L
authors.lastname: Thines
authors.affiliation: Service de neurochirurgie, Hôpital Charles-Nicolle, CHU de Rouen, 76038 Rouen, France.
authors.forename: F
authors.initials: F
authors.lastname: Proust
authors.affiliation: Clinique de neurochirurgie, Pôle des neurosciences et appareil locomoteur, CHRU de Lille, Université Lille Nord de France, 59000 Lille, France.
authors.forename: P
authors.initials: P
authors.lastname: Marinho
authors.affiliation: Clinique du Tonkin, 69626 Villeurbanne cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Durand
authors.affiliation: Department of Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: van der Zwan
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Regli
authors.affiliation: Clinique de neurochirurgie, Pôle des neurosciences et appareil locomoteur, CHRU de Lille, Université Lille Nord de France, 59000 Lille, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Lejeune
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D002548:Cerebral Revascularization / Q000379:methods; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008866:Microsurgery / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D016896:Treatment Outcome
keywords: Anévrisme géant intracrânien; Clippage; Clipping; Conventional bypass; Diversion de flux; ELANA; Extracranial-intracranial bypass; Flow diversion; Giant intracranial aneurysm; Intracranial-intracranial bypass; Nonocclusive bypass; Pontage conventionnel; Pontage extracrânien-intracrânien; Pontage intracrânien-intracrânien; Pontage non occlusif; Pontage radial; Pontage saphène; Radial artery bypass; Saphenous vein bypass; Stent; Stenting