Abstract
INTRODUCTION: Because of the advances in endovascular techniques, indications for cerebral revascularization in intracranial vascular pathologies have declined. We sought to define indications, highlight surgical strategies, and analyze clinical results of patients treated with bypass procedures in the endovascular era. METHODS: We retrospectively reviewed all bypass procedures performed from 1/2006 to 3/2013. The database was sub-divided into moyamoya angiopathy (MMA), intracranial aneurysms (IA), and intracranial occlusion diseases (IOD). RESULTS: A total of 225 bypass procedures were performed in 185 patients (mean age 46.2 years (1-80 years)). There were 135 direct and 90 indirect bypasses. The MMA group consisted of 129 bypasses (87 indirect, 42 direct) in 92 patients. The preoperative Glasgow Outcome Scale (GOS) was 4.29 and postoperative was 4.616. There were no deaths and 9 perioperative complications. The IA group had 58 patients (mean age 46.3, range (1-78)) with complex aneurysms (18 giant, 17 fusiform, 13 multilobulated, 7 blood-blister-like, 2 pseudoaneurysms, 1 mycotic). Ten were ruptured, 14 had cranial neuropathy, 3 brainstem compression, 3 strokes, 2 pseudoaneurysms and the rest had headaches. Forty-six were in the anterior and 12 in the posterior circulation. There were 7 deaths and 6 major complications. The IOD disease group included 38 bypasses in 35 patients. The etiology of the vascular occlusion was 24 atherosclerosis, 5 iatrogenic, 3 dissection, 1 vasculitis, and 2 vertebral artery dissection. The preoperative and postoperative GOS were 3.87 and 4.63. There were 4 periprocedural complications. More details of the procedures and patient outcomes will be presented. CONCLUSION: The emergence of new endovascular techniques has revolutionized the treatment of certain intracranial vascular pathologies. However, this series demonstrates the importance of cerebral revascularization in the neurosurgical armamentarium. Moyamoya angiopathy, complex intracranial aneurysms, and selected intracranial disease pathologies are the main groups that benefit from cerebral revascularization procedures.