{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:24:45Z","timestamp":1791617085652,"version":"4.3.4"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Because simple intracranial aneurysms (IAs) are increasingly treated endovascularly, neurovascular surgery has become focused on complex IAs that may require deconstructive aneurysm therapy with concomitant surgical bypass. The authors describe the decision-making process concerning cerebral revascularization and present outcomes that were achieved in a large case series of complex IAs managed with cerebral revascularization and parent artery occlusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors retrospectively reviewed the medical records, including neuroimaging studies, operative reports, and follow-up clinic notes, of all patients who were treated at the National Brain Aneurysm Center between July 1997 and June 2015 using cerebral revascularization as part of the management of an IA. They recorded the location, rupture status, and size of each IA, as well as neurological outcome using the modified Rankin Scale (mRS), aneurysm and bypass status at follow-up, and morbidity and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The authors identified 126 patients who underwent revascularization surgery for 126 complex, atheromatous, calcified, or previously coiled aneurysms. Ninety-seven lesions (77.0%) were unruptured, and 99 (78.6%) were located in the anterior circulation. Aneurysm size was giant (\u2265 25 mm) in 101 patients, large (10\u201324 mm) in 9, and small (\u2264 9 mm) in 16 patients. Eighty-four low-flow bypasses were performed in 83 patients (65.9%). High-flow bypass was performed in 32 patients (25.4%). Eleven patients (8.7%) underwent in situ or intracranial-intracranial bypasses. Major morbidity (mRS score 4 or 5) occurred in 2 (2.4%) low-flow cases and 3 (9.1%) high-flow cases. Mortality occurred in 2 (2.4%) low-flow cases and 2 (6.1%) high-flow cases. At the 12-month follow-up, 83 (98.8%) low-flow and 30 (93.8%) high-flow bypasses were patent. Seventy-five patients (90.4%) undergoing low-flow and 28 (84.8%) high-flow bypasses had an mRS score \u2264 2. There were no statistically significant differences in patency rates or complications between low- and high-flow bypasses.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>When treating challenging and complex IAs, incorporating revascularization strategies into the surgical repertoire may contribute to achieving favorable outcomes. In our series, low-flow bypass combined with isolated proximal or distal parent artery occlusion was associated with a low rate of ischemic complications while providing good long-term aneurysm control, potentially supporting its wider utilization in this setting. The authors suggest that consideration should be given to managing complex IAs at high-volume centers that offer a multidisciplinary team approach and the full spectrum of surgical and endovascular treatment options to optimize patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.4.jns172752","type":"journal-article","created":{"date-parts":[[2018,11,15]],"date-time":"2018-11-15T22:58:28Z","timestamp":1542322708000},"page":"1297-1307","source":"Crossref","is-referenced-by-count":25,"title":["Cerebral revascularization for the management of complex intracranial aneurysms: a single-center experience"],"prefix":"10.3171","volume":"131","author":[{"given":"Eric S.","family":"Nussbaum","sequence":"first","affiliation":[{"name":"National Brain Aneurysm Center, Department of Neurosurgery, United Hospital, St. Paul, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin M.","family":"Kallmes","sequence":"additional","affiliation":[{"name":"Duke University Law School, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Lassig","sequence":"additional","affiliation":[{"name":"National Brain Aneurysm Center, Department of Neurosurgery, United Hospital, St. Paul, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K.","family":"Goddard","sequence":"additional","affiliation":[{"name":"National Brain Aneurysm Center, Department of Neurosurgery, United Hospital, St. Paul, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Madison","sequence":"additional","affiliation":[{"name":"National Brain Aneurysm Center, Department of Neurosurgery, United Hospital, St. Paul, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie A.","family":"Nussbaum","sequence":"additional","affiliation":[{"name":"National Brain Aneurysm Center, Department of Neurosurgery, United Hospital, St. Paul, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.3171\/2015.5.JNS15368","article-title":"Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients","volume":"124","author":"Abla AA","year":"2016","unstructured":"Abla AA, McDougall CM, Breshears JD, Lawton MT: Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients. 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