Awake High-Flow Extracranial to Intracranial Bypass for Complex Cerebral Aneurysms: Institutional Clinical Trial Results

The Role of Neurophysiological Monitoring during Complex Aneurysm Surgery: Report of Two Cases and Review of the Literature

“…Therefore, developing a surgical strategy and additional intraoperative information is key in these cases. [1][2][3][4][5][6][7][8][9][10] Complex and giant aneurysms of the ICA (diameter > 2.5 cm) are sometimes associated with life-threatening complications such as a mass effect, thromboembolic ischemic stroke, and hemorrhage. Patients can deteriorate rapidly, with neurological deficits that can lead to death after the rupture of the aneurysm.…”

“…In our cases, the MEPs correlated with the postoperative neurological status. [2][3][4][5][6] Some reports highlight the use of other intraoperative strategies to address functional status during surgery. Some studies emphasize the use of micro Doppler probes to make real-time evaluations of arterial blood flow.…”

“…Some studies emphasize the use of micro Doppler probes to make real-time evaluations of arterial blood flow. [2][3][4][5][6] They are useful to analyze blood flow inside the aneurysm and especially after clipping, to evaluate the patency of the vessel. 5 In the case of the performance of a bypass, it is also useful to analyze the patency of the bypass.…”

“…They may also be classified according to the fundus/neck ratio and their content (thrombosed, partially thrombosed or calcified). [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Complex aneurysms are those with morphological irregularities, usually large or giant; thrombosed, partially thrombosed or calcified; with aberrant fundus/neck ratio, and near eloquent neurological structures. These cases demand special skills by the surgical team.…”

The First Awake Clipping of a Brain Aneurysm in Malaysia and in ASEAN: Achieving International Standards

“…Professor Abdulrauf was one of our external examiners in neurosurgery and had taught us techniques for cerebrovascular surgery that is conducted when the patient is awake. Clinical studies have proven that it is feasible and beneficial for some selected patients to remain awake during the surgery in which their brain aneurysms are clipped (1)(2)(3)(4)(5). The advantages of awake brain surgery are that it lowers the risks of brain ischemia with neurological deficits (stroke) and ventilator associated morbidities.…”