Cerebral Revascularization

Over the last half century, there has been significant progress in both the technique and the thought process involved in surgical cerebral revascularization. In this article, we review the state-of-the-art practice in cerebral revascularization, which includes the use of novel technologies and decision making in surgical techniques, in preoperative planning, and in postoperative monitoring. We also discuss the importance of flow measurement, a technique that has evolved the practice of cerebral revascularization by allowing for improved patient selection, appropriate patient-specific choice of bypass grafts, verification of intraoperative bypass success, and noninvasive and reliable postoperative follow-up. Technical advances in performing anastomosis aimed at reducing occlusion times during anastomosis are also discussed. Cerebral revascularization has truly become a state-of-the-art discipline involving cutting edge technology and demonstrating promising results. Nonetheless, much work remains to be carried out to further validate these methodologies and their impact on patient outcomes.