Surgical selection algorithms and long-term functional outcomes in microsurgical revascularization for complex...

Area of Science:

• Neurosurgery
• Vascular Surgery
• Neurology

Background:

• Complex intracranial aneurysms pose treatment challenges due to location or morphology.
• Direct clipping or standard endovascular methods may be unsuitable.
• Microsurgical revascularization is a critical alternative for select cases.

Purpose of the Study:

• Evaluate long-term functional outcomes of microsurgical revascularization for complex intracranial aneurysms.
• Assess the technical reliability of a hemodynamically driven surgical selection algorithm.
• Correlate aneurysm characteristics with surgical strategy and outcomes.

Main Methods:

• Retrospective analysis of 29 patients with complex intracranial aneurysms (2019-2025).
• Surgical strategies categorized into three bypass generations based on anatomy and hemodynamics.
• Functional outcomes assessed using modified Rankin Scale (mRS) at multiple time points.
• Statistical analysis including Friedman and Kruskal-Wallis tests.

Main Results:

• Significant correlation found between aneurysm diameter and bypass generation (p=0.0057).
• Favorable and stable functional outcomes observed over time (p<0.0001).
• Median mRS improved from 2 at discharge to 1 at 12 months; 86.2% achieved independence (mRS 0-2).
• 100% bypass patency confirmed with indocyanine green videoangiography and digital angiography.

Conclusions:

• Microsurgical revascularization is a reliable and effective strategy for complex intracranial aneurysms when other methods fail.
• A hemodynamically guided algorithm facilitates excellent graft patency.
• This approach supports favorable long-term functional recovery and independence.