Flow reversal bypass surgery for giant intracranial aneurysms: illustrative cases

For select patients with GIAs, proximal occlusion paired with flow reversal is a promising surgical technique that may balance aneurysm thrombosis with maintenance of distal and perforator perfusion. The significant procedural risks of FRB surgery must be balanced with the aggressive natural history of GIAs. Future directions include aneurysm and perforator vessel flow analysis and careful documentation of aneurysm filling following high-flow bypass. https://thejns.org/doi/10.3171/CASE2583.