A Combined Approach to Treatment of the Dissecting Middle Cerebral Artery Fusiform Aneurysm

Abstract

<jats:p> A fusiform aneurysm in the terminal M1 middle cerebral artery (MCA) segment was treated by a construction of a high-flow arterial extracranial-intracranial (EC-IC) bypass. Due to severe bypass vasospasms, local vasodilating agents together with percutaneous angioplasty and stent implantation were applied, but failed due to subsequent bypass occlusion. To remedy this complication a new bypass was created from a segment of the saphenous vein, followed by MCA aneurysm embolization and parent artery occlusion. One year after the surgery, the venous bypass remains patent and the aneurysm occluded, with the patient fully active, without any neurological sequelae. </jats:p>

Bypass surgery for complex middle cerebral artery aneurysms: an algorithmic approach to revascularization

“…32 A wide variety of bypass techniques for MCA aneurysms exist because they are so amenable to both traditional extracranial-to-intracranial (EC-IC) bypasses, such as superficial temporal artery (STA) bypass and high-flow interpositional bypass to the cervical carotid artery, and reconstructive IC-IC bypasses, such as the end-to-end reanastomosis and the double-reimplantation technique. 4,6,8,[11][12][13][14][17][18][19]22,25,28,[30][31][32][33][34]37,39,43,50,51 The pathological spectrum of MCA aneurysms combined with the variety of applicable bypasses makes it challenging to select the optimal bypass, particularly when these decisions must be made intraoperatively in response to unexpected anatomy or technical complications. To our knowledge, no algorithm to guide these decisions or surgical plans exists.…”