• Nnenna Mbabuike, Sophia F Shakur, Kelly Gassie, Visish Srinivasan, Justin Mascitelli, Adib Abla, Edward Duckworth, Peter Kan, Georgios A Zenonos, Clemens Schirmer, Fady T Charbel, Evandro de Olivera, Jacques J Morcos, Michael Lawton, and Rabih G Tawk.
• Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA.
• World Neurosurg. 2020 Feb 1; 134: e16-e28.

BackgroundFlow diversion has become increasingly popular for treatment of cerebral aneurysms in the past few years. In an increasing number of patients with aneurysms, flow diversion (FD) has failed, with a paucity of reported data regarding salvage treatment for these challenging cases.MethodsWe present a multicenter series of 13 aneurysms for which FD failed and that were subsequently treated with open surgery. We also present a review of the reported data regarding operative management of aneurysms after unsuccessful FD.ResultsTwelve patients with 13 aneurysms were included in the present study. All 12 patients had undergone surgery after FD because of persistent aneurysm filling, mass effect, or aneurysm rupture. The patients underwent aneurysm clipping and parent vessel reconstruction, decompression of the aneurysm mass, occlusion of proximal flow to the aneurysm, or aneurysm trapping with or without extracranial-intracranial artery bypass.ConclusionsAneurysms for which FD fails present a variety of unique and challenging management situations that will likely be encountered with increased frequency, given the popularity of FD. Microsurgical salvage options require individualized care tailored to the underlying pathological features, patient characteristics, and surgical expertise.Copyright © 2019 Elsevier Inc. All rights reserved.

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