Intracranial⁃intracranial bypass with interposition graft for the treatment of complex intracranial aneurysms

Abstract

Background Complex intracranial aneurysms are one of the most difficult cerebrovascular diseases to treat, and even experienced cerebrovascular surgeons face great challenges. Intracranial ‐ intracranial bypass with interposition graft has its unique surgical indications and technical points, but there is a lack of research reports in the literature at home and abroad. Methods Six patients with complex intracranial aneurysms who were cured by intracranial‐intracranial bypass with interposition graft from January 2015 to December 2023 in The First Medical Center of PLA General Hospital were enrolled, DSA was used to evaluate the patency of postoperative grafts and aneurysm development, modified Rankin Scale (mRS) was used to evaluate the neurological prognosis, and the procedure ‐ related complications such as cerebral infarction, intracranial hemorrhage, scalp nonunion, and forearm nerve dysfunction were recorded. Results All 6 patients successfully completed intracranial‐intracranial bypass with interposition graft, with superficial temporal artery (STA) in 5 cases and radial artery (RA) in one case. The grafts were embedded between the proximal and distal parent arteries in 2 cases, and the grafts were bridged between the distal donor and proximal donor in 2 cases, one case was reconstructed in a "Y" shape between the artery and the recipient artery, one case was reconnected proximally to the donor artery, and the distal end was anastomosed with the branch end ‐ to ‐ end. Postoperative DSA showed all aneurysms disappeared and the grafts were unobstructed. The average postoperative follow‐up was 23.67 months, and there was no recurrence of aneurysms and grafts occlusion, and the mean mRS score was 0.33 at the last follow ‐ up. There were no surgery ‐ related complications after surgery. Conclusions Intracranial ‐intracranial bypass with interposition graft is an effective method for the treatment of complex intracranial aneurysms, which has the technical advantages of strong flexibility, abundant variants and wide range of indications, and can provide more abundant, safe and effective individualized treatment strategies for cerebrovascular surgeons.

DOI: 10.3969/j.issn.1672‐6731.2024.08.006