Cerebral Bypass Surgery: Level of Evidence and Grade of Recommendation

Acta Neurochirurgica. Supplement
Giuseppe EspositoLuca Regli

Abstract

Cerebral bypasses are categorized according to function (flow augmentation or flow preservation) and to characteristics: direct, indirect or combined bypass, extra-to-intracranial or intra-to-intracranial bypass, and high-, moderate- or low-capacity bypass. We critically summarize the current state of evidence and grades of recommendation for cerebral bypass surgery. The current indications for cerebral bypass are discussed depending on the function of the bypass (flow preservation or augmentation) and analyzed according to level of evidence criteria. Flow-preservation bypass plays an important role in managing complex intracranial aneurysms (level of evidence 4; grade of recommendation C). Flow-preservation bypass is currently only very rarely indicated in the treatment of cerebral tumors involving major cerebral arteries (level of evidence 5; grade of recommendation D). The trend has evolved in favor of partial resection and radiotherapy. To preserve the flow, the bypass is always a direct bypass.Flow-augmentation bypass is currently recommended for Moyamoya patients with ischemic symptoms and compromised hemodynamics (level of evidence 4; grade of recommendation C) and patients with hemorrhagic onset (level of evidence 1B; g...Continue Reading

Citations

Jun 18, 2020·Therapeutic Advances in Neurological Disorders·Michael Moussouttas, Igor Rybinnik
Sep 9, 2020·Operative Neurosurgery·Daniel M S RaperAdib A Abla
Dec 11, 2020·Journal of Neurosurgical Sciences·Lelio GuidaGiuseppe Esposito
Apr 20, 2021·Journal of Neurosurgical Sciences·Sina FinkenstaedtGiuseppe Esposito

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