TITLE:
From Awake Carotid Occlusion to Saphenous-Vein High-Flow Bypass: Surgical Solutions for Complex Intracranial Aneurysms in a New
AUTHORS:
Nassourou Oumarou Haman, Ngbwa Ghislain Guea, Ronaldo Fonju Anu, Assiga Yves Martin Ahanda, Petridis Athanasios, Vincent de Paul Djientcheu
KEYWORDS:
Bypass, Vascular Neurosurgery, Superficial Temporal Artery, Middle Cerebral Artery, Shunt, Low Cerebral Perfusion, Aneurysm, Interposition Graft
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.16 No.2,
April
3,
2026
ABSTRACT: Background and Importance: The re-establishment of an on-site cerebrovascular fellowship in Cameroon enabled progressively more advanced open and hybrid treatments for complex intracranial aneurysms, including giant lesions and aneurysms associated with vasculopathy. In environments where endovascular resources are limited, extracranial-intracranial (EC-IC) bypass remains an essential technique to preserve or restore cerebral perfusion when parent-artery sacrifice or trapping is required. Clinical Cases: We report two illustrative cases in which EC-IC bypass was central to definitive management. Case 1: a 60-year-old woman with a symptomatic, giant cavernous internal carotid artery (ICA) aneurysm presenting with oculomotor palsy. The aneurysm was initially treated with distal ICA occlusion under awake anesthesia and appeared controlled; months later, the patient developed contralateral upper-extremity weakness and visual disturbance consistent with hypoperfusion. She subsequently underwent a high-flow CCA → saphenous-vein graft → M2 bypass with clinical improvement. Case 2: a 43-year-old man with subarachnoid hemorrhage from a wide-neck right M1-M2 aneurysm underwent a protective low-flow STA → M4 MCA bypass prior to definitive microsurgical clipping; trapping proved unnecessary and the patient recovered without neurologic deficit. Conclusions and Implications: EC-IC bypass techniques can be safely and effectively implemented in resource-limited cerebrovascular programs when teams are trained, basic microsurgical infrastructure is available, and perioperative systems are in place. These cases support strategic capacity-building—progressive skill development (STA-MCA → interposition grafts), targeted equipment investment, and rehabilitation pathways—to expand durable treatment options for complex aneurysms where endovascular solutions are unavailable or unsuitable.