Abstract
BackgroundChildren's complex middle cerebral artery (MCA) aneurysm is a relatively rare occurrence. When the huge aneurysm is located in the MCA bifurcation with an inconspicuous neck and involving numerous arteries, intravascular interventional surgery or aneurysm clipping are often difficult treatment options. At this point, high flow bypass revascularization is necessary as a treatment to preserve cerebral blood flow. In recent years, the internal maxillary artery (IMA) has gradually become the mainstream donor artery of thw high flow bypass. We performed internal maxillary artery -radial artery-middle cerebral artery (IMA-RA-MCA) and superficial temporal artery-middle cerebral artery (STA-MCA) bypass as the treatment of a complex MCA bifurcation aneurysm in consideration of the patient's condition and the advantage of the IMA. According to the author, this case is the youngest reported case of IMA-RA-MCA bypass at present.Case DescriptionA male child, 7 years and 8 months, was admitted to the hospital due to “recurrent headache for more than 9 months,” DSA indicated that there was a large wide-necked aneurysm at the bifurcation of the right MCA M1 segment, with a size of about 1.16*1.58*1.32 cm. The inflow path of the aneurysm was in front of M1 bifurcation, and one outflow path originated from the aneurysm body, and another small outflow path attached to the aneurysm body. After completing the preoperative evaluation, an extended pterional approach with zygomatic osteotomy was performed to fully expose the aneurysm and IMA, harvesting the left radial artery at the same time, then a STA-MCA bypass, IMA-RA-MCA bypass, and aneurysm trapping were performed. postoperative re-examination showed that bypass vessels and the distal middle artery vessels were patent and the aneurysm disappeared, the child has no neurological dysfunction.ConclusionsIMA-RA-MCA bypass is an effective high-flow cerebral blood reconstruct scheme in the treatment of complex middle cerebral artery bifurcation aneurysms. This case can provide a reference for the surgical treatment of complex middle cerebral artery bifurcation aneurysms in children.
Highlights
Nowadays, intracranial aneurysms are mostly treated by intravascular therapy
As to complex aneurysms located in the middle cerebral artery (MCA) bifurcation, considering the aneurysm wide-neck, involving potential lenticulostriate arteries and multiple branching arteries, conventional aneurysm clipping and endovascular treatment is often difficult to completely resect or isolate the aneurysm, and safeguard cerebral blood flow at the same time
In terms of the selection of reconstruction methods, Due to the complex vascular route of the aneurysm at the MCA bifurcation, it is generally accepted that middle or high flow bypass should be performed in the need of reconstructing the blood supply from MCA
Summary
Intracranial aneurysms are mostly treated by intravascular therapy. Especially in recent years, flow diversion devices (FDDs) have been widely proved to be safe for the treatment of complex cerebrovascular diseases, which is greatly expanding the indications for intracranial aneurysm treatment. Traditional microsurgery is still difficult to replace in the treatment of MCA M1 bifurcation aneurysms, especially when aneurysms have complex morphology and involve multiple branching arteries. Complex aneurysms of the middle cerebral artery are rare in children In this case, the patient was too young and the wide-neck aneurysm was located at the bifurcation of MCA and numerous vessels were involved. When the huge aneurysm is located in the MCA bifurcation with an inconspicuous neck and involving numerous arteries, intravascular interventional surgery or aneurysm clipping are often difficult treatment options. At this point, high flow bypass revascularization is necessary as a treatment to preserve cerebral blood flow. This case is the youngest reported case of IMA-RA-MCA bypass at present
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call