{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:15:37Z","timestamp":1783775737784,"version":"3.55.0"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2013,2]]},"abstract":"<jats:p>Large and giant anterior communicating artery (ACoA) aneurysms usually show partial thrombosis and incorporate both the A<jats:sub>1<\/jats:sub> and A<jats:sub>2<\/jats:sub> segments and crucial perforating vessels. Therefore, direct clip placement or endovascular strategies often fail, leaving cerebral bypass surgery as a relevant therapeutic option. The authors present 3 cases in which a giant or large ACoA aneurysm was successfully occluded using a new technique that applies a double-barrel radial artery bypass. A radial artery graft is modified into a Y-shaped double-barrel conduit. After both pterional and parasagittal craniotomies are carried out, the graft is tunneled between both sites and anastomosed in an end-to-side fashion proximally to either a superficial temporal artery (STA) or M<jats:sub>2<\/jats:sub> branch and distally to bilateral A<jats:sub>3<\/jats:sub> branches. Aneurysm occlusion is then conducted through the pterional or parasagittal craniotomy. In one case, a 42-year-old patient in whom an endovascular approach had failed, the authors performed an STA-A<jats:sub>3<\/jats:sub>-A<jats:sub>3<\/jats:sub> bypass and proximal aneurysm occlusion. In two others, a 49-year-old man in whom coiling had failed and a 56-year-old man in whom a giant ACoA aneurysm was partially thrombosed, the authors performed an M<jats:sub>2<\/jats:sub>-A<jats:sub>3<\/jats:sub>-A<jats:sub>3<\/jats:sub> double-barrel bypass followed by either proximal or distal aneurysm occlusion. Complete aneurysm occlusion with excellent bypass perfusion was documented in the first two cases. In the third case, the authors observed good bypass perfusion with persistent antegrade aneurysm filling, and thus endovascular coil embolization was added to completely occlude the aneurysm.<\/jats:p>\n<jats:p>The Y-shaped double-barrel bypass using a radial artery graft allows for safe and effective occlusion of large and giant ACoA aneurysms that cannot be treated by direct clip application.<\/jats:p>","DOI":"10.3171\/2012.11.jns121061","type":"journal-article","created":{"date-parts":[[2012,12,7]],"date-time":"2012-12-07T15:09:09Z","timestamp":1354892949000},"page":"444-450","source":"Crossref","is-referenced-by-count":23,"title":["The Y-shaped double-barrel bypass in the treatment of large and giant anterior communicating artery aneurysms"],"prefix":"10.3171","volume":"118","author":[{"given":"Julius","family":"Dengler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vajkoczy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns121061","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"E8","DOI":"10.3174\/ajnr.A1370","article-title":"Etiology of giant aneurysms and their treatment","volume":"30","author":"Alvarez","year":"2009"},{"key":"b2-jns121061","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"1150","DOI":"10.3174\/ajnr.A2907","article-title":"Flow-diverter silk stent for the treatment of intracranial aneurysms: 1-year follow-up in a multicenter study","volume":"33","author":"Berge","year":"2012"},{"issue":"4 Suppl 2","key":"b3-jns121061","series-title":"Neurosurgery","first-page":"279","article-title":"Surgical treatment of giant intracranial aneurysms: current viewpoint","volume":"63","author":"Cantore","year":"2008"},{"issue":"5","key":"b4-jns121061","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E5","DOI":"10.3171\/2009.2.FOCUS0918","article-title":"Giant serpentine aneurysms","volume":"26","author":"Christiano","year":"2009"},{"key":"b5-jns121061","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.3174\/ajnr.A2057","article-title":"Partially thrombosed intracranial aneurysms presenting with mass effect: long-term clinical and imaging follow-up after endovascular treatment","volume":"31","author":"Ferns","year":"2010"},{"issue":"6 Suppl 3","key":"b6-jns121061","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1289","DOI":"10.1227\/01.NEU.0000318092.86562.F","article-title":"Surgical treatment of complex intracranial aneurysms","volume":"62","author":"Hanel","year":"2008"},{"key":"b7-jns121061","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.surneu.2008.01.056","article-title":"Microneurosurgical management of anterior communicating artery aneurysms","volume":"70","author":"Hernesniemi","year":"2008"},{"key":"b8-jns121061","series-title":"Die luetische Erkrankung der Hirnarterien","author":"Heubner","year":"1874"},{"key":"b9-jns121061","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1227\/01.NEU.0000153927.70897.A2","article-title":"Thrombotic intracranial aneurysms: classification scheme and management strategies in 68 patients","volume":"56","author":"Lawton","year":"2005"},{"key":"b10-jns121061","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1227\/01.NEU.0000255452.20602.C9","article-title":"Deep hypothermic circulatory arrest for complex cerebral aneurysms: lessons learned","volume":"60","author":"Mack","year":"2007"},{"issue":"4 Suppl","key":"b11-jns121061","series-title":"Neurosurgery","first-page":"S53","article-title":"The supratentorial arteries","volume":"51","author":"Rhoton","year":"2002"},{"key":"b12-jns121061","series-title":"Neurosurgery","first-page":"993","article-title":"Anterior communicating artery aneurysms","volume":"51","author":"Riina","year":"2002"},{"key":"b13-jns121061","series-title":"Neuroradiology","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1007\/BF00451765","article-title":"Growth-mechanism of giant intracranial aneurysms; 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