Management of Complex Intracranial Aneurysms: Principles of Microsurgical Deconstruction and Cerebrovascular Bypass

Intracranial aneurysms may exhibit features that make them unsuitable for standard microsurgical and endovascular reconstructive strategies. For such lesions, deconstruction of the aneurysm and parent artery is often required, typically in association with a flow-replacement by pass procedure. The addition of a bypass helps minimize the risk of cerebral ischemia and infarction, particularly in the setting of subarachnoid hemorrhage (SAH). In this chapter, we present our management strategies for complex intracranial aneurysms and some of the technical nuances of microsurgical trapping and cerebral revascularization.