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Updated: Jun 1, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Cerebral revascularization: extracranial-intracranial bypass
1Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA. hanjani@uic.edu
Insights
Extracranial-intracranial (EC-IC) bypass surgery is vital for complex cerebrovascular diseases like aneurysms and moyamoya. Objective flow assessment improves patient selection, graft evaluation, and follow-up care for EC-IC bypass procedures.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Cerebrovascular Medicine
Background:
- Extracranial-intracranial (EC-IC) bypass is a key revascularization strategy for complex cerebrovascular conditions.
- Endovascular techniques have evolved, yet EC-IC bypass remains relevant for specific neurosurgical applications.
- Current data suggests limited utility for flow augmentation in cerebral ischemia, but it's crucial for selected athero-occlusive disease and symptomatic moyamoya disease.
Purpose of the Study:
- To highlight the enduring role of EC-IC bypass in managing complex cerebrovascular disease.
- To emphasize its relevance in flow replacement for complex/fusiform aneurysms and flow augmentation for specific ischemic conditions.
- To advocate for an objective, flow-based approach to optimize EC-IC bypass decision-making and outcomes.
Main Methods:
- Review of current clinical data and established indications for EC-IC bypass.
- Discussion of EC-IC bypass applications in aneurysm treatment, cerebral ischemia, and moyamoya disease.
- Proposal of a flow-based methodology for enhancing EC-IC bypass management.
Main Results:
- EC-IC bypass is essential for flow replacement before planned vessel sacrifice in complex and fusiform aneurysms.
- Its role in flow augmentation for cerebral ischemia is currently limited but remains viable for select athero-occlusive disease cases.
- EC-IC bypass is a primary treatment for symptomatic moyamoya disease.
Conclusions:
- EC-IC bypass continues to be a critical revascularization technique for specific cerebrovascular pathologies.
- An objective, flow-based approach can significantly improve patient selection, intraoperative assessment, and postoperative management of EC-IC bypass.
- This methodology enhances the overall efficacy and safety of EC-IC bypass surgery.
Abstract:
Extracranial-intracranial (EC-IC) bypass remains an important revascularization technique for management of complex cerebrovascular disease. Despite evolving endovascular techniques, the role of bypass for the purpose of flow replacement prior to planned vessel sacrifice remains relevant for treatment of complex and fusiform aneurysms. The role of bypass for purposes of flow augmentation in the setting of cerebral ischemia is limited based on current data, but remains an important option for selected cases of athero-occlusive disease, in addition to a primary treatment for symptomatic moyamoya disease. An objective flow-based approach to EC-IC bypass can enhance decision-making in preoperative patient selection, intraoperative graft assessment, and postoperative follow-up.
