The application of intracranial ⁃ intracranial bypass for the treatment of complex basilar artery aneurysms

Abstract

Objective To explore the surgical procedures and indications of intracranial ‐ intracranial bypass for the treatment of complex aneurysms in the basilar artery (BA). Methods and Results A retrospective analysis was conducted on the clinical data and treatment process of 6 patients with complex BA aneurysms who underwent intracranial‐intracranial bypass from April 2017 to April 2023 in Tianjin Huanhu Hospital. Among the 6 aneurysms, 3 were vertebro basilar dolichoectasia aneurysms, one was an aneurysm in the upper segment of BA combined with severe stenosis at the proximal of the aneurysm, and 2 were giant dissecting aneurysms of the BA. Among them, 5 were ruptured aneurysms, with one case of Hunt‐Hess grade Ⅴ, one case of grade Ⅳ, 2 cases of grade Ⅲ, and one case of grade Ⅱ, while the remaining one case was an unruptured aneurysm. One patient underwent petrous segment of internal carotid artery (ICA) ‐ radial artery (RA) ‐ posterior cerebral artery (PCA) bypass combined with aneurysm clipping, 4 patients underwent V3 segment of vertebral artery (VA) ‐ RA ‐ PCA bypass combined with aneurysm trapping, and one patient underwent middle cerebral artery (MCA)‐RA‐PCA bypass combined with aneurysm trapping. Four patients had good prognosis, with modified Rankin Scale (mRS) 0 to 3, one case scored 4 and one case died one week after surgery. Conclusions For complex aneurysms of the BA that cannot be treated with conventional methods, intracranial‐intracranial bypass provides a good option. It is necessary to select the appropriate surgical procedure based on the actual situation in clinical practice.

DOI: 10.3969/j.issn.1672‐6731.2024.08.005