‘Y’-Shaped Palmar Common Digital Artery Interposition Bypass in the Treatment of an Infantile M2 Large Aneurysm and Literature Review

Abstract

Both craniotomy and interventional embolization are difficult and risky to treat complex middle cerebral artery (MCA) aneurysms in infants. Trapping with revascularization is a therapeutic option for giant aneurysms that cannot be clipped or coiled alone. We describe a technical method using revascularization with a natural Y-shaped palmar common digital artery interposition graft that provides a normal variation for a complex MCA aneurysm in an infant with intracerebral hemorrhage at 37 days of age. Conservative treatment was performed at that time. Seven months later, the patient was re-admitted to the hospital and was confirmed a large aneurysm in the M2 segment of the right MCA by cerebral angiography. A natural artery palmar common digital artery Y-graft was used as the graft and anastomosed to the M2 and both M3 trunks. The symptoms improved after surgery, and the mRS score of the patient was 1 after 5 years of follow-up. The palmar common digital artery can be an option for intracranial revascularization bypass in complex intracranial aneurysms.