Cerebral Bypass Surgery for Treating Unclippable and Uncoilable Aneurysms

Kim, Jung Soo; Park, Sang Hyuk; Hong, Chang Ki; Huh, Jun Suk; Kang, Hyoung Lae; Joo, Jin Yang

Abstract

OBJECTIVE
Fusiform and dissecting aneurysms cannot be treated with conventional clipping or coiling surgery. Various methods are used for treating these aneurysms, including proximal occlusion of the parent artery or trapping the aneurysms with or without cerebral revascularization. We report here on our experience with treating unclippable and uncoilable aneurysms and we present the clinical and angiographic outcomes.
METHODS
Nine patients with unclippable and uncoilable aneurysms were managed during a 5 year period at our institution. We retrospectively reviewed all the patients with aneurysms and who underwent multimodal techniques. The mean age of the 9 patients was 56.5 years. The mean clinical follow-up period was 28.1 months. Six patients presented with subarachnoid hemorrhage and 2 had diplopia. Of these patients, 3 had aneurysms arising from the posterior inferior cerebellar artery (PICA), 2 had vertebral artery (VA) aneurysms, 2 had internal carotid artery aneurysms and 2 had middle cerebral artery aneurysms. Eight aneurysms were fusiform and 1 was a giant saccular aneurysm.
RESULTS
The treatment included surgical trapping with bypass in 4 patients, endovascular trapping with bypass in 4 patients and vein graft bypass in 1 patient. Among the bypass surgeries, high-flow bypass was performed for a giant internal cerebral artery (ICA) aneurysm. Trapping of the aneurysms with coil and occipital artery (OA)-PICA bypass were performed for 2 VA aneurysms of the PICA origin. There was no recurrent bleeding or ischemic symptoms during the follow-up periods.
CONCLUSION
The cerebral bypass technique is a useful, safe for the treatment of dissecting and otherwise unclippable/uncoilable aneurysms.