Surgical treatment | Cerebral bypass surgery
Cerebral bypass surgery is more or less comparable to bypass surgery of the heart or elsewhere in the body. The procedure consists of a bridging of the occluded blood vessel. A small artery of the forehead is dissected and connected to an artery of the brain in the area that receives too little blood. Another possibility is that a vein of the leg is used and connected in the neck to one of the arteries, and then diverted to one of the major cerebral arteries, by means of a small batch of skull. These treatments are carried out under the microscope so that the bypass graft surgery can be carried out with maximum precision.
The procedure is also known as an extra-to intracranial bypass (EC-IC bypass). For the bypass the superficial temporal artery is usually used. Often one can feel this artery beating on the sleep. This artery is dissected free on the outside of the skull and connected to one of the cerebral arteries inside the skull. This is done through a small hatch to the skull, which is placed back into place after the bypass is connected. The scar is usually only a few centimeters. It is proven that with these types of operations the risk of further stroke or TIAs is reduced and that patients with such bypass are less tired and feel fitter because of the better blood supply to the brain.
The stitching of the small arteries is done under the microscope with magnification of about 20 to 40-fold, and with a very thin bonding wire which is still thinner than a human hair. The duration of cerebral bypass surgery is approximately 2.5 - 3 hours.
The bypass procedures are sometimes used for very difficult to treat intracranial aneurysms that cannot be closed the classical way by means of coils or clips. In this case, the bypass is made to secure the blood flow to the brain. Subsequently, the aneurysm with the associated vessel can be closed either surgically or with endovascular coils.