Even though Flow Diverters (FDs) are becoming more and more common as an endovascular treatment for cerebral aneurysms, treating complicated aneurysms remains difficult. In certain circumstances, combined techniques utilizing a flowpreservation bypass may be taken into account. In this study, a group of patients who had complicated cerebral aneurysms and undergone bypass surgery were looked at. During the period of January 2015 to May 2022, 23 patients were chosen. We found 6 (26.1%) ACA aneurysms, 6 (26.1%) MCA aneurysms, and 11 (47.2%) ICA aneurysms. Eight were categorized as enormous, nine were fusiform, eight had intraluminal thrombosis, ten had wall calcification, and eighteen involved significant branches or perforating arteries. The mean maximal diameter was 12.16 mm. In 23 patients, 25 bypass surgeries were carried out (2 EC-IC bypasses with radial artery graft, 17 single-barrel or double-barrel STA– MCA bypasses and 6 IC-IC bypasses in anterior cerebral arteries). With a mean follow-up of 28 months, the long-term bypass patency rate was 94.5% and the total aneurysm exclusion was 95.6%. The median KPS values at the most recent follow-up were 90, and 87% of the cases had good results. When a simpler direct approach, including the use of FD, is deemed to be impractical, the use of bypass procedures can be a viable therapeutic alternative in the therapy of complicated anterior circulation aneurysms in some circumstances.
