The In Situ Side-To-Side Bypass Technique: A Comprehensive Review of the Technical Characteristics, Current Anastomosis Approaches, and Surgical Experience
Objective: In situ side-to-side (STS) revascularization is an intracranial-intracranial bypass technique that is increasingly used to treat complex aneurysms and cerebral ischemia. This sophisticated technique involves connecting 2 proximal parallel vessels to create an artificial conduit for blood flow. This study aims to provide a detailed description of the configuration of the STS bypass technique and extensive information regarding its technical characteristics, current anastomosis approaches, and surgical significance. Methods: A literature search was performed using the PubMed, Medline, ScienceDirect, Embase, Wiley Online Library, Cambridge Journals, SAGE Journals, Oxford Journals, Research Gate, and Google Scholar databases. The terms “intracranial-intracranial bypass,” “in situ bypass,” “communicating bypass,” and “STS anastomosis” were searched to identify pertinent articles. Articles involving in situ STS anastomosis combined with other bypass methods were excluded. Computer tablet-drawn illustrations of this technique are provided to enhance comprehension. Results: In total, 70 articles that met our search and inclusion criteria were identified. Overall, the radiographic and clinical outcomes of 132 (125 aneurysms and 7 cerebral ischemias) patients who underwent in situ STS revascularization were analyzed. Conclusions: Intracranial-intracranial bypass in the STS fashion can be a safe and effective strategy for the management of complex intracranial aneurysms and cerebral ischemia and is particularly attractive in rescue, anticipated, and troubleshooting cases. Despite its extreme rarity, a de novo aneurysm may be observed after STS anastomosis; thus, long-term follow-up is mandatory. Vascular neurosurgeons should consider including this procedure in their treatment armamentarium.
Digital Object Identifier (DOI)
Wang, Long; Cai, Li; Qian, Hai; Lawton, Michael T.; and Shi, Xiang'en, "The In Situ Side-To-Side Bypass Technique: A Comprehensive Review of the Technical Characteristics, Current Anastomosis Approaches, and Surgical Experience" (2018). Neurosurgery. 1286.