Bypass for unruptured aneurysm?

Has anyone had a bypass procedure done for an unruptured aneurysm? My husband and I saw this supposedly amazing, world renown surgeon in Seattle this week (our 3rd opinion so far) and he recommended a clipping, and possible wrapping of his 6mm fusiform basilar tip aneurysm. The doc also said he would have a bypass procedure on "standby" in case he needed it. I am not as familiar with the Bypass, it sounds terribly frightening to me. Is the recovery longer? Is it a riskier procedure overall?

HI Scarlett,

This isn't a procedure that I have personal experience of, but I know roughly what it involves - basically, they bypass the poor/dangerous blood supply reaching the brain from an internal cerebral artery - they do this by routing an external (as in on the outside of the skull) artery, via a craniotomy, and linking it in to meet the internal artery again. This allows them to bypass a section of internal artery which is damaged or blocked if it is impossible/impractical to fix what is wrong. By doing this, they can effectively just skip the damaged part, which stops being a danger if blood isn't being pumped through it any more.

In the case of fusiform aneurysms, the shape of the aneurysm makes it very tricky (not impossible though) to effectively treat without blocking/damaging the artery itself. The bypass seems to me like a very logical (and forward thinking) solution in case they cannot fix the aneurysm but want to correct the problem while the skull is already open for the attempted clipping process.

Again... I have no personal experience of the recovery, but from everything I can see on the 'net, it looks like a quite straightforward recovery with similar risks and issues to a standard clipping procedure. While it does sound very radical, re-routing arteries is actually quite commonplace these days (think of all those multiple heart bypass operations being done!) and surgeons are extremely skilled with these type of surgeries. I believe the key factors for swift/effective recovery from cerebral bypass are likely to be the same as with heart bypass - age, general health and how well you follow the guidelines to rest and recuperate correctly afterwards.

I found a good guide from the Mayfield Clinic (or at least it looks good to me at a quick glance) for cerebral bypass surgery that is well worth a quick read-through as it explains the procedure in detail and also describes recovery:

I hope that helps some to give you a better guide to what is going on - if it is any comfort, were I in the situation of having a difficult fusiform aneurysm, I'd want my neuro team to be considering the bypass surgery - I think it is a much more satisfying approach than the "wait and see" that is usually advised with aneurysms which may be difficult to treat with the standard clipping/coiling methods.


Hi Scarlett
My aneurysm was bulging out in two spots and had a very wide neck. Based on the location of the aneurysm, my doctor thought it might be necessary to do a bypass to protect the blood flow. I wound up with 3 clips. Luckily the blood flow was not compromised. The way it was explained, he would connect a vein to another vein to “bypass” the aneurysm keeping the blood flowing. It was estimated to add another 2 1/2 hours to surgery time. I was told that it would not add any more risk and would not add to recovery time. While the procedure sounds frightening, the possible risk of stroke due to compromised blood flow was more frightening.
By the way, which doctor told you about the bypass?

Hi Scarlett,

Interesting, I found the Mayfield site also easy to read / comprehend (for me, that is a challenge) ...

Additionally, the BAF main site lists two books on Brain aneurysms by a Dr. Eric Nussbaum and one by Dr. Robert Spetzler...I put them in this forum site as subject "Two Books" ...highly recommend them...

Prayers for your successful decisions and results...


I had a bypass and occulsion done in May. They took the vein from my leg and cut open the carroid attery in the neck and tied the vein in there and then tied the vein in past where the annie was and then they put clips in to kill off the annine in my head. It never bothered my leg they told me lots of people complain about the leg wound but that did not bother me much It was the god alful headache that I had when I awoke from the surgery. The risks that the neurosurgeon told me were about the same as the risks that the other sugions told me. The only difference was that this one would help me go back to normal with 95% sucess rate. While all other procedures that the docs spoke about were only 70% sucess rate. I recovered and have been told I am doing great even though I have some visions issues and a droppy eye. I still have sound sensitivty and headaches which I am now seeing a neurologist to hopefully fix.. But overall my hospital stay was a tab bit longer then they thought but only cuz my boby did not want wake up after the surgey and it took me about a week to came back to life so to speak so instead of being in the 2 weeks they thought I ended up in the hospital about 3 weeks. If I had to do it over I would still go with the same doc and have the same procuder as I am alive and have no perminement issues except for droppy eye and they told me that before I had it done.. Good luck with what ever choice you make and keep us posted on how things go. God Bless

This was a very informative, helpful link Bruce, thank you so much. I do like that our doc is going into this procedure with a 'back up' plan.

No worries, Scarlett, am glad it was some use to you - and yes, I really do agree. I think it is a very logical and clear approach which gives confidence that your doc has a great grasp of the scenario and is actively thinking about what is best instead of just doing a default procedure and not questioning the specifics of the case.

Best of luck for an excellent outcome!

Terri, 2 different surgeons mentioned a possible bypass, the one in town that we saw and then, most recently, the Seattle surgeon we went to see last week. We are contemplating a November surgery date, in Seattle. We like and trust our Portland neurosurgeon but feel like it's wise to go with the most experienced doctor. But have to weight that against the realities of being out of town for 2-3(or 4??) weeks, especially with 2 school-age children. But my gut says we need the very best. And at least we have family in Seattle.

Will look into those books. Thank you Pat.

How long did your vision issues last?

My eye opened in aprox 3 weeks after surgery. I still 3 months later still when I am tired I have a hard time holding the eye open more then a little but the double vision that I had was gone about a week after the eye opened. It then was blury gor a bit still have some issues when I am tired. Headaches arw my bigest issue sti ll have them more then I care too

May I ask your surgeons name? Mine is in Seattle too, Dr. Louis Kim, and I trust him completely. I have been at Harborview hospital repeatedly and find the care to be better than most, though you do have to be proactive still (I recommend this with any medical facility!).