{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T13:34:24Z","timestamp":1781357664610,"version":"3.54.1"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"21","license":[{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,5,26]]},"abstract":"\n BACKGROUND<\/jats:title>\n Giant intracranial aneurysms (GIAs) have no definitive treatment paradigm. Flow reversal bypass (FRB) through high- or low-flow extracranial-to-intracranial bypass may facilitate aneurysm thrombosis while maintaining perforator patency, yet predicting when FRB will be successful remains challenging. The authors compared 2 patients with GIAs after FRB surgery to illustrate the successes and possible pitfalls.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The first patient was a 13-year-old boy with giant, partially thrombosed, unruptured aneurysms of the internal carotid artery and upper basilar artery. The second patient was a 38-year-old man with a giant unruptured proximal middle cerebral artery (MCA) M1 aneurysm. Both underwent FRB. The child\u2019s upper basilar aneurysm resolved completely without complication. The adult experienced progressive aneurysm recanalization after initial thrombosis and associated MCA territory infarct requiring a subsequent trapping procedure with clipping of distal outflow, which has not been described previously.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n For select patients with GIAs, proximal occlusion paired with flow reversal is a promising surgical technique that may balance aneurysm thrombosis with maintenance of distal and perforator perfusion. The significant procedural risks of FRB surgery must be balanced with the aggressive natural history of GIAs. Future directions include aneurysm and perforator vessel flow analysis and careful documentation of aneurysm filling following high-flow bypass.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE2583<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case2583","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T20:17:45Z","timestamp":1748290665000},"source":"Crossref","is-referenced-by-count":2,"title":["Flow reversal bypass surgery for giant intracranial aneurysms: illustrative cases"],"prefix":"10.3171","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6234-7080","authenticated-orcid":true,"given":"Madeleine","family":"de Lotbiniere-Bassett","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Hasen","sequence":"additional","affiliation":[{"name":"Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William T.","family":"Couldwell","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","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","year":"2016","unstructured":"Lawton MTAbla AARutledge WCBypass surgery for the treatment of dolichoectatic basilar trunk aneurysms: a work in progress. Neurosurgery. 2016;79(1):83-99."},{"key":"bib2","series-title":"World Neurosurg","first-page":"e119","article-title":"Surgical management of giant intracranial aneurysms: overall results of a large series","volume":"144","author":"Luzzi","year":"2020","unstructured":"Luzzi SGragnaniello CGiotta Lucifero ADel Maestro MGalzio R.Surgical management of giant intracranial aneurysms: overall results of a large series. World Neurosurg. 2020;144:e119-e137."},{"issue":"6","key":"bib3","series-title":"Neurosurgery","first-page":"1261","article-title":"Giant intracranial aneurysms: evolution of management in a contemporary surgical series","volume":"69","author":"Sughrue","year":"2011","unstructured":"Sughrue MESaloner DRayz VLLawton MT.Giant intracranial aneurysms: evolution of management in a contemporary surgical series. Neurosurgery. 2011;69(6):1261-1271."},{"key":"bib4","series-title":"Neurosurgery","first-page":"ons116","article-title":"Flow diversion radial artery bypass graft coupled with terminal basilar artery occlusion for the treatment of complex basilar apex aneurysms: operative nuances","volume":"72","author":"Mai","year":"2013","unstructured":"Mai JCTariq FKim LJSekhar LN.Flow diversion radial artery bypass graft coupled with terminal basilar artery occlusion for the treatment of complex basilar apex aneurysms: operative nuances. Neurosurgery. 2013;72:ons116-ons126."},{"issue":"5","key":"bib5","series-title":"Neurosurgery","first-page":"763","article-title":"Bypass and flow reduction for complex basilar and vertebrobasilar junction aneurysms","volume":"72","author":"Kalani","year":"2013","unstructured":"Kalani MYZabramski JMNakaji PSpetzler RF.Bypass and flow reduction for complex basilar and vertebrobasilar junction aneurysms. Neurosurgery. 2013;72(5):763-776."},{"issue":"suppl 3","key":"bib6","series-title":"Neurosurgery","first-page":"E493","article-title":"Twenty-year follow-up of flow reversal and revascularization for a giant serpentine basilar artery aneurysm","volume":"10","author":"Kalani","year":"2014","unstructured":"Kalani MYZabramski JMNakaji PSpetzler RF.Twenty-year follow-up of flow reversal and revascularization for a giant serpentine basilar artery aneurysm. Neurosurgery. 2014;10(suppl 3):E493-E497."},{"issue":"24","key":"bib7","series-title":"J Neurosurg Case Lessons","first-page":"CASE23613","article-title":"High-flow bypass for giant dolichoectatic vertebrobasilar aneurysms: illustrative cases","volume":"6","author":"Shaw","year":"2023","unstructured":"Shaw RJukes AKAllan RS.High-flow bypass for giant dolichoectatic vertebrobasilar aneurysms: illustrative cases. 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Neurol India. 2018;66(3):661-663."},{"issue":"8","key":"bib20","series-title":"J Neurointerv Surg","first-page":"777","article-title":"Computational fluid dynamics of cerebral aneurysm coiling using high-resolution and high-energy synchrotron X-ray microtomography: comparison with the homogeneous porous medium approach","volume":"9","author":"Levitt","year":"2017","unstructured":"Levitt MRBarbour MCRolland du Roscoat SComputational fluid dynamics of cerebral aneurysm coiling using high-resolution and high-energy synchrotron X-ray microtomography: comparison with the homogeneous porous medium approach. J Neurointerv Surg. 2017;9(8):777-782."},{"issue":"1","key":"bib1","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","year":"2016","unstructured":"Lawton MTAbla AARutledge WCBypass surgery for the treatment of dolichoectatic basilar trunk aneurysms: a work in progress. Neurosurgery. 2016;79(1):83-99."},{"key":"bib2","series-title":"World Neurosurg","first-page":"e119","article-title":"Surgical management of giant intracranial aneurysms: overall results of a large series","volume":"144","author":"Luzzi","year":"2020","unstructured":"Luzzi SGragnaniello CGiotta Lucifero ADel Maestro MGalzio R.Surgical management of giant intracranial aneurysms: overall results of a large series. 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Neurosurgery. 2014;10(suppl 3):E493-E497."},{"issue":"24","key":"bib7","series-title":"J Neurosurg Case Lessons","first-page":"CASE23613","article-title":"High-flow bypass for giant dolichoectatic vertebrobasilar aneurysms: illustrative cases","volume":"6","author":"Shaw","year":"2023","unstructured":"Shaw RJukes AKAllan RS.High-flow bypass for giant dolichoectatic vertebrobasilar aneurysms: illustrative cases. J Neurosurg Case Lessons. 2023;6(24):CASE23613."},{"issue":"2","key":"bib8","series-title":"Neurosurgery","first-page":"ONS105","article-title":"High-flow bypass grafts in the management of complex intracranial aneurysms","volume":"60","author":"Mohit","year":"2007","unstructured":"Mohit AASekhar LNNatarajan SKBritz GWGhodke B.High-flow bypass grafts in the management of complex intracranial aneurysms. Neurosurgery. 2007;60(2suppl 1):ONS105-ONS122."},{"issue":"7","key":"bib9","series-title":"Clin Neurol Neurosurg","first-page":"674","article-title":"Surgical management of giant intracranial aneurysms","volume":"110","author":"Sharma","year":"2008","unstructured":"Sharma BSGupta AAhmad FUSuri AMehta VS.Surgical management of giant intracranial aneurysms. Clin Neurol Neurosurg. 2008;110(7):674-681."},{"issue":"4","key":"bib10","series-title":"J Neurosurg","first-page":"1028","article-title":"Successful obliteration and shrinkage of giant partially thrombosed basilar artery aneurysms through a tailored flow reduction strategy with bypass surgery","volume":"114","author":"Miyamoto","year":"2011","unstructured":"Miyamoto SFunaki TIihara KTakahashi JC.Successful obliteration and shrinkage of giant partially thrombosed basilar artery aneurysms through a tailored flow reduction strategy with bypass surgery. J Neurosurg. 2011;114(4):1028-1036."},{"issue":"3","key":"bib11","series-title":"J Neurointerv Surg","first-page":"237","article-title":"Treatment of coil embolization failed recurrent giant basilar tip aneurysms with bypass and surgical occlusion","volume":"2","author":"Ramanathan","year":"2010","unstructured":"Ramanathan DCiporen JGhodke BEllenbogen RGSekhar LN.Treatment of coil embolization failed recurrent giant basilar tip aneurysms with bypass and surgical occlusion. J Neurointerv Surg. 2010;2(3):237-241."},{"issue":"6","key":"bib12","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","year":"2012","unstructured":"Siddiqui AHAbla AAKan PPanacea or problem: flow diverters in the treatment of symptomatic large or giant fusiform vertebrobasilar aneurysms. J Neurosurg. 2012;116(6):1258-1266."},{"issue":"6","key":"bib13","series-title":"Stroke","first-page":"1473","article-title":"SCENT Trial","volume":"50","author":"Meyers","year":"2019","unstructured":"Meyers PMCoon ALKan PTWakhloo AKHanel RATrial S.SCENT Trial. Stroke. 2019;50(6):1473-1479."},{"issue":"6","key":"bib14","series-title":"Neurosurgery","first-page":"1289","article-title":"Surgical treatment of complex intracranial aneurysms","volume":"62","author":"Hanel","year":"2008","unstructured":"Hanel RASpetzler RF.Surgical treatment of complex intracranial aneurysms. Neurosurgery. 2008;62(6suppl 3):1289-1299."},{"issue":"5","key":"bib15","series-title":"Neurosurgery","first-page":"1223","article-title":"Progressive growth of a giant dolichoectatic vertebrobasilar artery aneurysm after complete hunterian occlusion of the posterior circulation: case report","volume":"55","author":"O'Shaughnessy","year":"2004","unstructured":"O'Shaughnessy BAGetch CCBendok BRParkinson RJBatjer HH.Progressive growth of a giant dolichoectatic vertebrobasilar artery aneurysm after complete hunterian occlusion of the posterior circulation: case report. Neurosurgery. 2004;55(5):1223."},{"issue":"1-2","key":"bib16","series-title":"Acta Neurochir (Wien)","first-page":"27","article-title":"Long-term results of wrapping of intracranial ruptured aneurysms","volume":"103","author":"Fujiwara","year":"1990","unstructured":"Fujiwara SFujii KNishio SFukui M.Long-term results of wrapping of intracranial ruptured aneurysms. 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