BACKGROUND: Giant, or complex, @entity438 (ACA) are rare, but their surgical treatment is important. The authors describe their experiences with bypasses for @entity438 and discuss the new classification of ACA bypasses, the concept of using bypasses for insurance during the approach to the @entity439 , and simplifying the surgical algorithms for these @entity438 . METHODS: Over a 19-year period, 7 cases of complex ACA @entity439 were treated with bypasses and reviewed retrospectively. The bypasses were classified into 4 groups according to donor blood flow: internal carotid artery (IC)-ACA, external carotid artery (EC)-ACA, communicating bypass, and reconstruction bypass of the ipsilateral postcommunicating ACA. RESULTS: The cases included 1 precommunicating @entity439 , 3 communicating @entity439 , 2 postcommunicating @entity439 , and 1 double @entity439 (communicating and postcommunicating). The types of bypass included 1 IC-ACA, 6 communicating bypasses, 3 EC-ACAs, and 2 reconstruction bypass of the postcommunicating ACA. Postoperative modified Rankin Scale scores were 0 (6 cases) and 3 (1 case of a communicating @entity439 with complicated memory disturbance because of @entity1188 ). One case revealed asymptomatic @entity1188 . CONCLUSION: Surgical treatment of @entity438 requires knowledge of a variety of bypass techniques. Although the type of bypass should be selected according to @entity1 -specific anatomy and the neurosurgeon's preference, the new classification of bypass-specified @entity438 may alter the way surgeons think about ACA bypasses, and in combination with the concept of the protective bypass, can be used to establish a comprehensive algorithm for each type of complex ACA @entity439 .

Surgical strategy for XXXX : retrospective case series and literature review.

@entity1 :: ('9606', 'Species') :: ['patient'] @entity439 :: ('MESH:D000783', 'Disease') :: ['aneurysms', 'aneurysm'] @entity1188 :: ('MESH:D007238', 'Disease') :: ['infarction'] @entity438 :: ('MESH:D002532', 'Disease') :: ['ACA aneurysms', 'aneurysms of the anterior cerebral artery', 'complex ACA aneurysms']
@entity438 :: (MESH:D002532,Disease) :: ['complex anterior cerebral artery aneurysms']
