Complex Intracranial Aneurysms: Strategies for Surgical Trapping and Cerebral Revascularization

Intracranial aneurysms that are neither clippable nor coilable often require a deconstructive procedure to eliminate the risk of hemorrhage. In that setting, cerebral revascularization may become necessary to replace blood flow after parent artery sacrifice and, in the case of ruptured aneurysms, to prevent delayed cerebral ischemia. In this chapter, we guide the reader through the process of surgical decision-making in these challenging cases, as we elaborate on the management strategies and some of the technical nuances of microsurgical trapping and bypass.