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The re-anastomosis end-to-end bypass technique: a comprehensive review of the technical characteristics and surgical experience

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Abstract

Re-anastomosis end-to-end bypass is a straightforward subtype of intracranial-intracranial reconstruction technique that has been utilized to treat complex aneurysms and skull base tumors. This simple technique involves connecting the cut ends of an afferent and efferent artery under added tension after excising the lesion. The current study aims to provide a detailed description of the technical pitfalls, ideal anatomical sites and indications, and clinical outcomes for intracranial complex disorders. A literature search was performed using the terms “intracranial-intracranial bypass,” “re-anastomosis bypass,” “reconstructive bypass,” “end-to-end bypass,” and “end-to-end anastomosis” to identify pertinent articles. Articles involving end-to-end re-anastomosis combined with other bypass methods were excluded. Computer-tablet-drawn illustrations of this technique are provided to enhance comprehension. Eighty-six patients who met our search and inclusion criteria were identified between 1978 and the present. However, comprehensive descriptions of medical records and neuroimaging were available in only 41 cases (40 complex aneurysms and a skull base tumor). Of 40 reported cases of complex cerebral aneurysms treated by this technique, the overall rate of full recovery without complication is 87.5% (35/40). Meanwhile, all aneurysms were completely eliminated from the circulation, with 92.5% of bypasses being patent. End-to-end re-anastomosis remains a simple modality in the microsurgical bypass armamentarium. Safe and effective surgical outcomes can be achieved in select cases that rarely involve perforators or branches.

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Funding

We received financial support from the Beijing Municipal Natural Science Foundation (Grant No. 7161005 to X.S.) and the Science and Technology Commission Foundation of Beijing (Grant No. Z161100000516019 to X.S.)

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Authors and Affiliations

  1. Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, No. 50, Yikesong Rd, Haidian District, Beijing, 100093, China

    Long Wang, Hai Qian & Xiang’en Shi

  2. Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan

    Long Wang & Rokuya Tanikawa

  3. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

    Long Wang & Michael Lawton

  4. Department of Neurosurgery, The First Affiliated Hospital of University of South China, Hengyang, China

    Li Cai

  5. Arkansas Neuroscience Institute, St. Vincent Hospital, Little Rock, AR, USA

    Li Cai

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  1. Long Wang
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Wang, L., Cai, L., Qian, H. et al. The re-anastomosis end-to-end bypass technique: a comprehensive review of the technical characteristics and surgical experience. Neurosurg Rev 42, 619–629 (2019). https://doi.org/10.1007/s10143-018-1036-z

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