Cerebrovascular Bypass Surgery

Restoring Blood Flow to the Brain

Cerebrovascular bypass surgery creates new pathways for blood to reach the brain when normal blood vessels are blocked, narrowed, or need to be sacrificed during treatment of complex conditions. This highly specialized procedure requires extensive microsurgical training and experience.

My fellowship training in cerebrovascular and skull base surgery at UCSF—one of the world's leading centers for bypass surgery—provided intensive experience in these complex revascularization techniques. This training allows me to offer bypass surgery as an option for patients who might otherwise have limited treatment choices.

Conditions Treated with Bypass Surgery

Moyamoya Disease

Moyamoya disease is a rare condition in which the major arteries at the base of the brain progressively narrow and become blocked. The body attempts to compensate by developing small collateral vessels, but these are often insufficient, leading to strokes and other complications.

Bypass surgery is the primary treatment for moyamoya disease. By creating new blood flow pathways to the brain, we can reduce the risk of stroke and improve symptoms. Both direct bypass (connecting a scalp artery directly to a brain artery) and indirect revascularization techniques may be used.

Complex Intracranial Aneurysms

Some large or giant aneurysms cannot be safely treated with clipping, coiling, or flow diversion alone. In these cases, bypass surgery can provide an alternative blood supply to the brain, allowing the aneurysm-bearing artery to be safely occluded. This is an advanced technique reserved for the most challenging aneurysms.

Intracranial Atherosclerotic Disease

Intracranial atherosclerosis causes narrowing of the arteries within the brain, which can lead to strokes. While most patients are managed medically, selected patients with symptomatic intracranial atherosclerotic disease who fail medical therapy may benefit from bypass surgery to restore adequate blood flow.

Types of Bypass Procedures

STA-MCA Bypass (Direct Bypass)

The most common cerebrovascular bypass connects the superficial temporal artery (STA)—a branch of the external carotid artery that runs along the scalp—to the middle cerebral artery (MCA) on the brain surface. This microsurgical anastomosis (connection) requires suturing vessels that are approximately 1-2mm in diameter.

High-Flow Bypass

When more blood flow is needed than the STA can provide, we may use a vein or artery graft (often from the leg or arm) to create a higher-capacity bypass from the neck to the brain.

Indirect Revascularization

Particularly for moyamoya disease, indirect techniques such as EDAS (encephaloduroarteriosynangiosis) or multiple burr holes can encourage new blood vessel growth into the brain over time. These may be used alone or in combination with direct bypass.

Why Choose Dr. Walcott for Bypass Surgery?

• UCSF Fellowship Training: Specialized training at one of the world's premier cerebrovascular surgery programs
• Comprehensive Expertise: Ability to offer both direct and indirect revascularization techniques
• Harvard Foundation: Rigorous residency training at Massachusetts General Hospital
• Full-Spectrum Care: Expertise in both open and endovascular approaches allows selection of the best treatment for each patient
• Research Leadership: Published extensively on cerebrovascular surgery techniques