Cerebrovascular disease: Edited by Cornelius Weiller and Jens FiehlerRevival of extra-intracranial bypass surgeryVajkoczy, PeterAuthor Information Department of Neurosurgery, Universitätsmedizin Charitè, Berlin, Germany Correspondence to Peter Vajkoczy, MD, Department of Neurosurgery, Charite Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany Tel: +49 30 450 560002; fax: +49 30 450 560900; e-mail: [email protected] Current Opinion in Neurology: February 2009 - Volume 22 - Issue 1 - p 90-95 doi: 10.1097/WCO.0b013e32832187f1 Buy Metrics Abstract Purpose of review Extra-intracranial bypass surgery has regained significant relevance over the past years. The aim of this review is to highlight the current indications and recent developments in this field. Recent findings One main indication today is stroke prevention by flow augmentation in the setting of chronic cerebral hemodynamic ischemia which is defined as a combination of steno-oclusive cerebrovascular disease, inadequate collateralization, and loss of cerebrovascular reserve capacity. Another indication is flow replacement in the context of therapy of complex aneurysms and skull base tumors. The herein proposed revival of bypass surgery is due to the progress in individualized, tailored therapeutic strategies as well as patient selection. Furthermore, we witness a dramatic improvement in the surgical technique as well as the development of a broad armamentarium of different bypass types, which today allow tailored revascularization strategies for our patients. Finally, the revival of bypass surgery is also explained by significant technical progress. One of the major developments within the last years is the Excimer laser-assisted nonocclusive anastomosis technique which allows performance of an anastomosis without the need for temporary clipping, thus dramatically reducing the risk for perioperative ischemia in bypass surgery. Summary Extra-intracranial bypass surgery has become a central part of a highly specialized, interdisciplinary strategy for the therapy of complex aneurysms and skull base tumors. © 2009 Lippincott Williams & Wilkins, Inc.