2019 Volume 47 Issue 5 Pages 349-354
The treatment of complex cerebral aneurysms, such as large/giant aneurysms, dissecting aneurysms, and recurrent aneurysms after endovascular therapy, is often challenging. Bypass procedures for the management of complex aneurysms could be a treatment option. We retrospectively reviewed patients with complex aneurysm who underwent bypass surgery between April 2006 and December 2016. The necessity of bypass was determined by balloon test occlusion (BTO) for all unruptured aneurysms. Ruptured/unruptured aneurysms were 5/21 cases, and high-flow bypass/lowflow bypass were 11/15 cases, respectively. Twenty of 21 patients with unruptured aneurysms showed a favorable outcome (modified Rankin Scale 0-2), while only 1 of 5 patients with ruptured aneurysms had a favorable outcome. In conclusion, the results of our surgical strategy for unruptured complex aneurysms under BTO algorithm were acceptable; however, the results of ruptured complex aneurysms had issues to be solved. To improve the safety of the treatment for complex aneurysms, bypass procedure is useful and sometimes mandatory.
