The use of combined revascularization surgery for successful elimination of a middle cerebral artery aneurysm

Abstract

The study objective is to present a clinical case of successful surgical treatment of a complex middle cerebral artery (MCA) aneurysm using various types of bypasses. A 59-year-old female patient presented with nontraumatic intracranial hemorrhage caused by rupture of a complex right MCA aneurysm. The anatomical features of the MCA aneurysm were identified using computed tomography (CT) in angiographic and 3D modes. The surgical intervention included aneurysmectomy and an end-to-end reanastomosis between the M1 and M2 segments of the MCA followed by an extra-intracranial microvascular anastomosis (EICMA) between the frontal branch of the right superficial temporal artery (STA) and the cortical branch of the right MCA located on the frontal lobe surface. The intraoperative blood flow via an intra-intracranial bypass (IC-IC bypass) was 30 mL/min, and the linear velocity of blood flow (LVBF) was 50 cm/s; the blood flow and LVBF via the STA-MCA bypass were 7-8 mL/min and 15 cm/s, respectively. CT angiography performed on the 1st postoperative day revealed the patency of the IC-IC and STA-MCA bypasses. The patient was discharged in satisfactory condition (Glasgow Outcome Scale -V) 1 month after surgery. Revascularization surgery is the sought-after surgical technique for complex intracranial aneurysms that enables efficient exclusion of the aneurysm from blood flow and prevention of ischemic brain injuries in the carrying artery territory.