The arborization bypass: Sequential intracranial-intracranial bypasses for an unruptured fusiform MCA aneurysm

Revascularization techniques are being featured more prominently as endovascular treatments continue to select out complex cerebrovascular pathologies for open surgical management. The current healthcare environment requires decreased hospital stays and improved clinical outcomes despite the growing complexity of open surgical cases. Recent efforts to reduce operative room time and decrease risk for bypass surgery have focused on avoiding graft harvest and maintaining the entire bypass intracranial. The presented technique features an arborization bypass to serially anastomose the middle cerebral artery vessels allowing for proximal trapping of a complex aneurysm without graft harvest. The arborization technique has several advantages to traditional techniques and serves to supplement the revascularization surgeon's armamentarium.