title: Surgical Flow Alteration for the Treatment of Intracranial Aneurysms That Are Unclippable, Untrappable, and Uncoilable.
abstract: OBJECTIVE
  The treatment of complex intracranial aneurysms remains challenging. One approach is the application of surgical flow alteration to treat aneurysms that are neither clippable, trappable, or coilable. The efficacy and limitations of surgical flow alteration have not yet been established.
  
  
  METHODS
  Cases of complex aneurysms treated with surgical flow alteration (proximal occlusion with or without bypass, distal occlusion with or without bypass and bypass only) were included in this retrospective study.
  
  
  RESULTS
  Among a total of 16 cases, there were 7 giant aneurysms (≥25 mm diameter) and 9 large aneurysms (>10 mm diameter); 15 of 16 aneurysms were unruptured. There were 8 aneurysms located in the anterior circulation, while the other 8 were in the posterior circulation. Aneurysms were treated with proximal occlusion in 10 cases and distal occlusion in 5 cases; in 1 case, the aneurysm occluded spontaneously after bypass without parent artery occlusion. All but 2 cases underwent prior or concurrent bypass surgery. Complete obliteration of the aneurysm at the latest imaging follow-up was shown in 12 of 16 cases (75.0%). Bypass patency was confirmed in 13 of 15 cases (86.7%). Surgery-related morbidity developed in 3 cases (18.8%, Glasgow outcome scale of 4) and all were perforator infarctions. There were no mortalities.
  
  
  CONCLUSIONS
  Surgical flow alteration resulted in a high rate of aneurysmal obliteration with acceptable morbidity. Although several limitations remained, it could represent an alternative method for treating complex aneurysms.
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jae Sung
authors.initials: JS
authors.lastname: Ahn
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Byung Duk
authors.initials: BD
authors.lastname: Kwun
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Wonhyoung
authors.initials: W
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jung Cheol
authors.initials: JC
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Roh
keywords: Aneurysm; Brain; Bypass; Clipping; Revascularization; Surgery
references.citation: J Neurosurg. 1996 Jul;85(1):178-85
references.pmid: 8683271
references.citation: World Neurosurg. 2014 Sep-Oct;82(3-4):535.e5-9
references.pmid: 24067739
references.citation: Br J Neurosurg. 2004 Jun;18(3):259-67
references.pmid: 15327228
references.citation: Neurosurgery. 2013 Mar;72(3):428-35; discussion 435-6
references.pmid: 23208054
references.citation: Neuroradiology. 1994 Oct;36(7):530-6
references.pmid: 7845578
references.citation: Neurosurgery. 2005 Jul;57(1 Suppl):140-5; discussion 140-5
references.pmid: 15987580
references.citation: Neurosurgery. 1992 Aug;31(2):360-4
references.pmid: 1513444
references.citation: Surg Neurol. 1997 Nov;48(5):473-6
references.pmid: 9352811
references.citation: Surg Neurol. 1999 Jan;51(1):94-8
references.pmid: 9952130
references.citation: J Neurosurg. 1992 Sep;77(3):478-80
references.pmid: 1506900
references.citation: Surg Neurol. 1994 Mar;41(3):221-5
references.pmid: 8146737
references.citation: J Neurosurg. 2001 Jul;95(1):24-35
references.pmid: 11453395
references.citation: J Korean Neurosurg Soc. 2010 Sep;48(3):259-62
references.pmid: 21082055
references.citation: J Neurosurg. 2006 Nov;105(5):788
references.pmid: 17121148
references.citation: J Neurosurg. 2009 Jul;111(1):78-83
references.pmid: 19301964
references.citation: J Neurosurg. 1983 Jun;58(6):824-31
references.pmid: 6854374
references.citation: Neurosurgery. 1996 Jan;38(1):83-92; discussion 92-4
references.pmid: 8747955
references.citation: Neurol Med Chir (Tokyo). 2004 Nov;44(11):587-90
references.pmid: 15686178
references.citation: AJNR Am J Neuroradiol. 1995 Apr;16(4):749-54
references.pmid: 7611033
references.citation: J Korean Neurosurg Soc. 2010 Aug;48(2):177-80
references.pmid: 20856671
references.citation: J Neurosurg. 1992 May;76(5):863-6
references.pmid: 1564547
references.citation: J Neurosurg. 1994 Feb;80(2):336-7
references.pmid: 8283276
references.citation: Neurosurgery. 2013 Jun;72(2 Suppl Operative):ons116-26; discussion ons126
references.pmid: 23313975
references.citation: Neurosurgery. 1994 Jun;34(6):1072-4
references.pmid: 8084393
references.citation: Clin Neuropathol. 2008 Jan-Feb;27(1):37-52
references.pmid: 18257473
references.citation: J Neurosurg. 2009 Mar;110(3):469-74
references.pmid: 19012486
references.citation: Neurosurg Rev. 1998;21(2-3):189-93
references.pmid: 9795960
references.citation: Neurosurgery. 1982 May;10(5):600-3
references.pmid: 7099411
references.citation: Acta Neurochir (Wien). 1992;117(1-2):23-9
references.pmid: 1514425
references.citation: World Neurosurg. 2015 Feb;83(2):197-202
references.pmid: 24933242
references.citation: J Neurosurg. 2007 Mar;106(3):484-7
references.pmid: 17367074
references.citation: Neurosurgery. 2006 Mar;58(3):434-42; discussion 434-42
references.pmid: 16528182
references.citation: J Neurosurg. 1993 Aug;79(2):161-73
references.pmid: 8331396
references.citation: Neurosurg Clin N Am. 1998 Oct;9(4):725-42
references.pmid: 9738103
references.citation: AJNR Am J Neuroradiol. 2006 Apr;27(4):766-8
references.pmid: 16611761
references.citation: J Neurosurg. 2011 Apr;114(4):1028-36
references.pmid: 20932097
references.citation: J Neurosurg. 1994 Nov;81(5):656-65
references.pmid: 7931611
references.citation: Neurosurgery. 2011 Jun;68(2 Suppl Operative):294-9; discussion 299
references.pmid: 21368700
references.citation: J Neurosurg. 1997 Aug;87(2):141-62
references.pmid: 9254076
references.citation: AJNR Am J Neuroradiol. 1992 Jul-Aug;13(4):1143-6
references.pmid: 1636527
references.citation: Neurosurgery. 2009 Oct;65(4):670-83; discussion 683
references.pmid: 19834371