Cerebrovascular bypass for ruptured aneurysms: A case series

Area of Science:

• Neurosurgery
• Vascular Surgery
• Neurology

Background:

• Aneurysmal subarachnoid hemorrhage (aSAH) presents limited treatment options for patients unsuitable for endovascular or open surgery.
• Data on the safety and efficacy of surgical bypass in aSAH management is scarce.

Purpose of the Study:

• To investigate the complications and functional outcomes of bypass surgery in a cohort of aSAH patients.
• To assess the viability of bypass as a revascularization strategy in complex aSAH cases.

Main Methods:

• Retrospective analysis of a prospective single-surgeon database of aSAH patients treated between 2013 and 2018.
• Inclusion of patients who underwent bypass surgery (extracranial-intracranial or intracranial-intracranial).
• Recording and analysis of perioperative mortality, in-hospital complications, and functional status at discharge and follow-up.

Main Results:

• Forty aSAH patients underwent bypass surgery (23 EC-IC, 17 IC-IC).
• All-cause perioperative mortality was 13% (6 patients).
• At discharge and 14-month follow-up, 40% and 64% of patients, respectively, achieved a Glasgow Outcome Score of 4-5.
• 70% experienced in-hospital complications, including 50% with ischemic complications and 18% with open surgical complications.

Conclusions:

• Surgical bypass is a feasible option for aSAH patients unsuitable for conventional treatments.
• Despite significant complication rates, bypass offers a necessary revascularization strategy in select complex aSAH cases.
• This study represents the largest modern series on bypass for aSAH, highlighting its role in challenging clinical scenarios.