title: Trends in Cerebral Revascularization in the Era of Pipeline and Carotid Occlusion Surgery Study.
abstract: BACKGROUND
  In the past, microsurgical bypass was the best option for revascularization of cerebrovascular lesions that required flow replacement or flow augmentation. Over the last 2 decades with advancements in the field of neuroendovascular surgery, especially with the revolution of flow diverting stents as well as the results of the Carotid Occlusion Surgery Study, indications for microvascular bypass have significantly decreased. The purpose of this study was to evaluate trends in cerebral revascularization over the past 8 years.
  
  
  METHODS
  We retrospectively reviewed patients with cerebral revascularization surgery during the years 2006-2014 in a single surgeon's practice. All patients who had undergone cerebral revascularization for any indication were included in the study.
  
  
  RESULTS
  We identified 106 patients who had undergone cerebral bypass; 2 patients were excluded. Of 104 patients, 60% were female and 40% were male. Indications for surgery were giant aneurysm in 48 patients, arterial occlusion in 30 patients, and moyamoya disease in 26 patients. In all indications except for moyamoya disease, case number per year declined. A marked decrease was noted in revascularization for treatment of giant aneurysm or occlusion.
  
  
  CONCLUSIONS
  This study demonstrates the impact that both scientific inquiry and technologic advances have had on a challenging and valuable technique in cerebrovascular surgery. Indications for both flow replacement and augmentative bypass remain. However, the marked decline in indications may have an indelible impact on maintenance of surgical proficiency as well as the ability for young neurosurgeons to develop this valuable skill set.
authors.affiliation: Department of Neurosurgery, Hofstra Northwell School of Medicine, Hempstead, and Lenox Hill Hospital, New York, New York, USA.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: White
authors.affiliation: Department of Neurosurgery, Hofstra Northwell School of Medicine, Hempstead, and Lenox Hill Hospital, New York, New York, USA.
authors.forename: Devon
authors.initials: D
authors.lastname: O'Donnell
authors.affiliation: Department of Neurosurgery, Hofstra Northwell School of Medicine, Hempstead, and Lenox Hill Hospital, New York, New York, USA.
authors.forename: Jackie
authors.initials: J
authors.lastname: Rosenthal
authors.affiliation: Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Department of Neurosurgery, Hofstra Northwell School of Medicine, Hempstead, and Lenox Hill Hospital, New York, New York, USA.
authors.forename: Gunes
authors.initials: G
authors.lastname: Aygok
authors.affiliation: Department of Neurosurgery, Maimonides Medical Center, New York, New York, USA.
authors.forename: Erez
authors.initials: E
authors.lastname: Nossek
authors.affiliation: Department of Neurosurgery, Hofstra Northwell School of Medicine, Hempstead, and Lenox Hill Hospital, New York, New York, USA. Electronic address: dlanger@nshs.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Langer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery; D002548:Cerebral Revascularization / Q000639:trends*; D002648:Child; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult
keywords: Cerebral bypass; Cerebral revascularization; EC-IC bypass; Giant cerebral aneurysm; Moyamoya disease