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Vascular reconstruction of intracranial lesions is sometimes required during various operations. A few examples are: A3-A3 side-to-side anastomosis for anterior communicating aneurysm in order to secure the blood flow to the distal anterior cerebral artery, STA-radial artery graft-A3 hemi-bonnet bypass for bilateral injury of the anterior cerebral artery, and direct stitching for aneurysmal neck laceration, etc. In this paper we describe the various techniques of vascular reconstruction for intracranial lesions and tumors. Some special microsurgical instruments, such as a micro-needle folder for stitching in a deep field, should be sterilized individually, and be ready for use at any time because injury to vessels in a deep operative field occurs suddenly. If the injured vessels are reconstructed quickly and completely, the neurological deficits after surgery can be limited and at times even prevented. Therefore veins or arteries that are or have been damaged should be reconstructed as much as possible.

The internal carotid artery (ICA) is sometimes involved with neck and skull base tumors or aneurysms, requiring elective ICA occlusion. This paper describes our strategy for vascular reconstruction after the ICA occlusion and the long-term follow-up results.Elective ICA occlusion was performed in 24 patients with unclippable aneurysms or tumors more than 2 years ago. The series comprises 5 males and 19 females, ranging in age from 32 to 75 (a mean age of 54.3). The lesions involved 5 tumors involving the ICA and 19 unclippable ICA aneurysms. Vascular reconstruction was determined by flowchart based on the balloon occlusion test with monitoring by clinical evaluation, EEG and cerebral blood flow (CBF) measurements. High-flow external carotid-internal carotid (EC-IC) bypass (including skull base bypass) was performed in 18 cases, superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in 4, and replacement using vascular prosthesis in 1. Bypass was not performed in 1 aged patient because adequate CBF was preserved. All bypass grafts have remained patent postoperatively. Two patients have developed mild ischemic complications in the 4.0-year follow-up.Hemodynamic stroke risk should be examined before elective ICA occlusion when low flow (STA-MCA) bypass or no reconstruction is chosen. Vascular reconstruction is an effective surgical approach in the treatment of tumors involving the ICA and unclippable aneurysms to prevent late ischemic complications.