1127. Intracranial-intracranial bypass with a graft vessel: a comprehensive review of technical characteristics and surgical experience

Authors: Long Wang, MD, PhD; Long Wang (Phoenix, AZ)

Introduction: Intracranial-intracranial (IC-IC) bypass with interposition graft bypass (IBGV) is a straightforward arterial reconstruction technique for treating complex aneurysms and skull base tumours. Here, we describe its technical characteristics and summarize clinical results for IBGV in complex cerebrovascular disorders. Methods: A literature search was performed using the PubMed (https://www.ncbi.nlm.nih.gov/pubmed/) and Google Scholar online databases. The terms “intracranial-intracranial bypass”, “jump graft bypass”, “interposition graft bypass”, “radial artery graft bypass”, “saphenous vein graft bypass” and “superficial temporal artery graft bypass” were searched. Articles involving IC-IC bypass with an interposition graft combined with other bypass methods were excluded. Illustrations of this technique are provided to enhance comprehension. Results: Fifty-eight cases involving six types of graft vessels were identified between 1978 and July 2018. The IBGV technique was further divided into four subtypes: 1) in situ interpositional graft bypass (IIGB); 2) “Y”-shape double-barrel IIGB; 3) long “jump” bypass (LJGB); and 4) “Y”-shape double-barrel LJGB. Grafts from the radial (43.1%, 25/58) and superficial temporal (39.7%, 23/58) arteries were the most active participants as vessels, and middle cerebral artery territory was the most commonly involved in IBGV. Of the 53 cases described with postoperative characteristics, the graft patency and overall uneventful rates were 96.2% and 81.4%, respectively. Conclusion: The IBGV technique remains a technically feasible option for vascular diseases or complex cerebral tumours that should be considered by neurosurgeons. Arterial grafts are preferred when using intracranial bypass techniques. A significant amount of training (performed in a microvascular anastomosis laboratory) is required to achieve an effective level of proficiency in these procedures.