Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Akita, Japan.
Adv Tech Stand Neurosurg. 2022;44:225-238. doi: 10.1007/978-3-030-87649-4_12.
Complex intracranial aneurysms remain challenging to treat using standard microsurgical or endovascular techniques. These aneurysms often require a combination of deconstructive and reconstructive procedures, such as parent artery occlusion, flow alteration, and blind-alley formation with or without bypass surgery, for effective and enduring therapeutic effects. It is important to determine the type of bypass based on the site of occlusion of the patent artery, anatomical features of the distal vessels, and expected adequate blood flow. In this chapter, we describe the "Standards," "Advances," and "Controversies" in the context of a microsurgical treatment strategy for complex intracranial aneurysms. "Standards" include a combination of frequent and commonly used procedures that have been gathering a certain consensus on their effectiveness. "Advances" include infrequent, demanding, and/or uncertain surgical procedures that are currently under debate. Finally, "Controversies" discuss a number of unsolved issues.
复杂颅内动脉瘤使用标准的显微外科或血管内技术治疗仍然具有挑战性。这些动脉瘤通常需要结合破坏性和重建性手术，如母动脉闭塞、血流改变以及盲端形成，伴或不伴旁路手术，以获得有效和持久的治疗效果。根据通畅动脉的闭塞部位、远端血管的解剖特征以及预期的足够血流来确定旁路类型非常重要。在这一章中，我们将描述复杂颅内动脉瘤的显微外科治疗策略的“标准”、“进展”和“争议”。“标准”包括经常使用且已在有效性方面达成一定共识的常见手术的组合。“进展”包括不常见、要求高且/或不确定的手术，目前仍存在争议。最后，“争议”讨论了一些未解决的问题。
