The efficacy of bypass surgery using a short interposition graft for the treatment of intracranial complex aneurysm

To evaluate the efficacy of a short interposition graft using saphenous vein or radial artery to connect the proximal superficial temporal artery and the M2 segments of the middle cerebral artery for the treatment of complex intracranial aneurysm.

From March 2007 to February 2012, short interposition graft bypass operations were performed in 13 patients with complex intracranial aneurysms. There were 6 ruptured aneurysms, including blood blister-like aneurysms in 3 patients, giant aneurysms in 2 patients, and fusiform dissecting aneurysm in 1 patient. Among 7 patients with unruptured aneurysms, there were 5 giant aneurysms and 2 large fusiform aneurysms in the M2 segment.

Parent artery occlusion with endovascular coiling (3 patients) or trapping by direct clipping (10 patients) was used to treat complex cerebral aneurysms. Complete occlusion of the aneurysm was demonstrated in 11 patients (85%); the other 2 patients did not demonstrate occlusion immediately postoperatively. Except for 2 patients who presented with poor-grade subarachnoid hemorrhage, patients (n = 11; 85%) demonstrated good scores on the Glasgow Outcome Scale. No new neurologic deficits developed in relation to insufficient blood flow through the bypass graft. In all 13 patients, graft patency was good at long-term follow-up (overall mean follow-up, 28.2 months).

Superficial temporal artery-middle cerebral artery bypass surgery using a short interposition graft for intracranial complex aneurysms seems to be safe and efficient hemodynamically after occlusion of the parent artery. It could be regarded as a good alternative to high-flow bypass surgery.