Cerebral bypass surgery for skull base lesions: Technical notes incorporating lessons learned over two decades

Object. Despite advancements in endovascular neurosurgery, there remains an important role for cerebral bypass surgery in the treatment of skull base lesions. The authors describe their replacement cerebral bypass surgery techniques incorporating lessons learned over 2 decades. Methods. The authors performed a retrospective review of cerebral bypass surgery performed by the senior author for skull base lesions between 1986 and 2006. One hundred patients had adjunct bypass surgery for skull base lesions. Results. The bypass surgeries performed are conceptually divided into Skull Base Bypass I, II, and III. The majority of lesions requiring bypass surgery were giant cavernous carotid artery aneurysms or skull base meningiomas. There were no deaths in this case series. There was a 7% morbidity rate. Conclusions. The ability to perform this surgery is an important adjunct in the armamentarium of skull base/cerebrovascular neurosurgeons.