A ruptured middle cerebral artery aneurysm originating from the site of anastomosis 20 years after extracranial-intracranial bypass for moyamoya disease:case report

De Novo Giant Partially Thrombosed Aneurysm Complicating STA-MCA Bypass Site in 3 Years

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19] Most of the cases found in the literature occur after STA-MCA bypass for cerebro-occlusive disease. This represents the second case we have found wherein there is an aneurysm complicating the bypass site following ICA occlusion for management of ICA aneurysms.…”

“…6 Only 16 cases have been previously reported, all of them followed bypass procedures for cerebro-occlusive diseases, such as stroke and moyamoya disease (Table 1). [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] …”

Intracerebral Hemorrhage From a Ruptured Aneurysm at the Site of Anastomosis 27 Years After Superficial Temporal Artery-Middle Cerebral Artery Bypass -Case Report-

“…3,4,[7][8][9]11,12,15,18) Such complications usually occur within a few years after bypass surgery. Only 3 of the 12 previous aneurysms at the anastomosis site, as well as the aneurysm in our patient, ruptured more than 2 years after STA-MCA bypass surgery.…”

“…The experience of such complications several years after bypass surgery has suggested that hypertension and hemodynamic stress might be a factor in the development of aneurysm at the anastomosis site. 11,12,18) Therefore, long-term careful and constant control of blood pressure has been recommended. 12) In addition, repeated long-term follow-up MR angiography should be performed to confirm the patency of the anastomosis and to identify aneurysm formations after STA-MCA anastomosis.…”

“…Moreover, formation of aneurysm more than several years after STA-MCA anastomosis is quite rare, with only 3 reported cases. 11,12,18) We describe a very rare case of intracerebral hemorrhage (ICH) from a ruptured aneurysm at the site of anastomosis 27 years after STA-MCA bypass.…”