Extracranial – Intracranial bypass surgery for large and complex cerebral aneurysms: An institutional experience in Vietnam

Abstract

Objective: Large or complex intracranial aneurysms treated with extracranial-intracranial bypass surgery and short-term results were reported. We also highlighted our decision-making impacted by social and financial factors and our technical note of good performance in a low middle-income country with limited resources. Method: We retrospectively reviewed medical records of all patients with intracranial aneurysms treated in our institution, from 2016 to 2019 and patients with large and complex aneurysms undergoing flow bypass surgery to describe. Case description: 4 patients with large and complex cerebral aneurysms were included. 2 patients with cavernous sinus and extracranial ICA aneurysms underwent high-flow bypass followed by proximal ICA ligation, 2 patients with large and complex MCA aneurysms were treated with low-flow bypass. All patients were evaluated before and after surgery and confirmed to be aneurysm-free by DSA and CTA. The mean follow-up period was 21.5 months (12–42 months). Conclusion: High-flow bypass with ICA ligation and low-flow bypass in the treatment of large and complex intracranial aneurysms are safe and cost effective surgical techniques in Vietnam with no ischemic complications and good patency, potentially supporting their wider application in the clinical setting in a low middle-income country. Careful evaluation before surgery enabled surgeons to decide surgery needs, which type of flow bypass to perform, which grafts should be harvested, which graft route. Considerations should be given under a multidisciplinary team approach and cost-effective consultation.

Keywords

• High flow bypass
• Low flow bypass
• Large and complex aneurysms
• Limited resources