2018 AANS Annual Scientific Meeting-Bypass Surgery… 50 Years Plus: Past, Present, Future

Video Transcription

Video Summary

In this video, Luca Regli discusses the history and current indications of bypass surgery in neurosurgery. He begins by mentioning that the first bypass surgery was performed by Yazargil 50 years ago and explains that the development of microsurgery and visualization tools played a key role in its advancement. Regli then discusses the decline of bypass surgery in the 1980s due to the bypass study and emphasizes that the focus is now on indications rather than techniques. He explains that the main indications for bypass surgery are to preserve flow in cerebral aneurysms and to augment flow in patients with hypoperfusion. Regli mentions that there is strong evidence for bypass surgery in Moyamoya disease and some evidence for its use in cerebral tumors. However, he notes that there is not enough evidence to support bypass surgery for atherosclerotic disease, as shown in the COST study. Regli suggests that future directions in bypass surgery should focus on patient selection, understanding the disease, and reducing perioperative risks. He also mentions the potential use of bypass surgery in acute stroke cases with ongoing symptoms or persistence of penumbra. In conclusion, Regli highlights the importance of preserving the skill of microanastomosis and suggests that referral centers should handle complex bypass surgeries.

Asset Caption

Luca Regli, MD, IFAANS (Switzerland)

Keywords

bypass surgery

neurosurgery

indications

Moyamoya disease

cerebral tumors

acute stroke