{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T13:34:25Z","timestamp":1781357665494,"version":"3.54.1"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"24","license":[{"start":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T00:00:00Z","timestamp":1702252800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Giant fusiform dolichoectatic vertebrobasilar artery aneurysms are challenging lesions with a poor natural history. When there is progressive brainstem compression from these lesions, endovascular treatment can be insufficient, and bypass surgery remains a possible salvage option. High-flow bypass surgery with proximal occlusion can potentially arrest aneurysm growth, promote aneurysm thrombosis, and reduce rupture risk. The authors describe their experience in two patients with giant fusiform dolichoectatic vertebrobasilar artery aneurysms treated with high-flow bypass.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>Both patients presented with enlarging giant dolichoectatic vertebrobasilar aneurysms causing symptomatic brainstem compression. The authors performed staged treatment involving high-flow bypass from the external carotid artery to the posterior cerebral artery using a saphenous vein graft, Hunterian proximal vertebrobasilar occlusion, and finally posterior fossa decompression with or without direct aneurysm thrombectomy and debulking. Postoperative angiography revealed successful flow reversal, aneurysm exclusion, and no brainstem stroke. Clinically, one patient had improvement in their modified Rankin Scale (mRS) score from 3 preoperatively to 1 at 12-month follow-up. The second patient had a deterioration in their mRS score from 4 to 5 at 12-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>High-flow bypass strategies remain high risk but can be a viable last resort in patients with neurological deficits and enlarging giant fusiform dolichoectatic vertebrobasilar artery aneurysms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23613","type":"journal-article","created":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T19:30:27Z","timestamp":1702323027000},"source":"Crossref","is-referenced-by-count":3,"title":["High-flow bypass for giant dolichoectatic vertebrobasilar aneurysms: illustrative cases"],"prefix":"10.3171","volume":"6","author":[{"given":"Richard","family":"Shaw","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alistair Kenneth","family":"Jukes","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia; and"},{"name":"Department of Neurosurgery, Royal Adelaide, Adelaide Women\u2019s and Children\u2019s Hospitals, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney Stewart","family":"Allan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9","key":"b1","series-title":"AJNR Am J Neuroradiol","first-page":"1747","article-title":"Aneurysms of the vertebrobasilar junction: incidence, clinical presentation, and outcome of endovascular treatment","volume":"28","author":"Peluso JPP","year":"2007","unstructured":"Peluso JPP, van Rooij WJ, Sluzewski M, Beute GN. Aneurysms of the vertebrobasilar junction: incidence, clinical presentation, and outcome of endovascular treatment. AJNR Am J Neuroradiol. 2007;28(9):1747\u20131751."},{"issue":"1","key":"b2","series-title":"Neurosurgery","first-page":"83","article-title":"Bypass surgery for the treatment of dolichoectatic basilar trunk aneurysms: a work in progress","volume":"79","author":"Lawton MT","year":"2016","unstructured":"Lawton MT, Abla AA, Rutledge WC,  Bypass surgery for the treatment of dolichoectatic basilar trunk aneurysms: a work in progress. 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J Neurosurg. 2018;128(2):560\u2013566."},{"issue":"3","key":"b7","series-title":"J Neurosurg","first-page":"255","article-title":"Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms","volume":"43","author":"Drake CG","year":"1975","unstructured":"Drake CG. Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms. J Neurosurg. 1975;43(3):255\u2013274."},{"issue":"3","key":"b8","series-title":"J Neurosurg","first-page":"560","article-title":"Vertebrobasilar occlusion therapy of giant aneurysms. Significance of angiographic morphology of the posterior communicating arteries","volume":"60","author":"Pelz DM","year":"1984","unstructured":"Pelz DM, Vi\u00f1uela F, Fox AJ, Drake CG. Vertebrobasilar occlusion therapy of giant aneurysms. Significance of angiographic morphology of the posterior communicating arteries. J Neurosurg. 1984;60(3):560\u2013565."},{"issue":"6","key":"b9","series-title":"J Neurosurg","first-page":"1258","article-title":"Panacea or problem: flow diverters in the treatment of symptomatic large or giant fusiform vertebrobasilar aneurysms","volume":"116","author":"Siddiqui AH","year":"2012","unstructured":"Siddiqui AH, Abla AA, Kan P,  Panacea or problem: flow diverters in the treatment of symptomatic large or giant fusiform vertebrobasilar aneurysms. J Neurosurg. 2012;116(6):1258\u20131266."},{"issue":"5","key":"b10","series-title":"J Neurointerv Surg","first-page":"493","article-title":"Meta-analysis of treatment outcomes of posterior circulation non-saccular aneurysms by flow diverters","volume":"10","author":"Kiyofuji S","year":"2018","unstructured":"Kiyofuji S, Graffeo CS, Perry A,  Meta-analysis of treatment outcomes of posterior circulation non-saccular aneurysms by flow diverters. J Neurointerv Surg. 2018;10(5):493\u2013499."},{"issue":"1","key":"b11","series-title":"J Clin Neurosci","first-page":"1","article-title":"High flow extracranial-to-intracranial brain bypass surgery","volume":"20","author":"Sia SF","year":"2013","unstructured":"Sia SF, Morgan MK. High flow extracranial-to-intracranial brain bypass surgery. J Clin Neurosci. 2013;20(1):1\u20135."},{"issue":"3","key":"b12","series-title":"Surg Neurol","first-page":"285","article-title":"Revascularizing the upper basilar circulation with saphenous vein grafts: operative technique and lessons learned","volume":"66","author":"Russell SM","year":"2006","unstructured":"Russell SM, Post N, Jafar JJ. Revascularizing the upper basilar circulation with saphenous vein grafts: operative technique and lessons learned. 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