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

Abstract

A 77-year-old female presented with a very rare case of intracerebral hemorrhage (ICH) from a ruptured aneurysm at the site of the anastomosis 27 years after superficial temporal artery-middle cerebral artery (STA-MCA) bypass manifesting as sudden onset of unconsciousness and right hemiparesis. Computed tomography (CT) on admission demonstrated massive ICH in the left frontoparietal region. Magnetic resonance angiography showed good patency of the anastomosis and no obvious aneurysm, but threedimensional CT (3D-CT) angiography revealed a small aneurysm at the site of the left STA-MCA anastomosis. Emergency evacuation of the hematoma was performed, and the aneurysm was trapped and resected after ligation. After the operation, she continued to exhibit deep consciousness disturbance. Unfortunately, her general condition grew steadily worse and she died 3 months later. Patients who undergo STA-MCA anastomosis should be carefully followed up by periodical imaging examinations. 3D-CT angiography is very useful to detect aneurysm formation at the anastomosis site.

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

“…16 It is also the second case in the literature to report a giant aneurysm related to the bypass site. 17 This is the first patient to suffer from partially thrombosed giant aneurysm, which presented with only headache and it is the largest bypass-related aneurysm reported yet.…”

“…[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] …”

De Novo Aneurysm Formation at the Anastomosis Site Incidentally Detected 2 Years after Single-Barrel STA-MCA Bypass Surgery: Case Report and Review of the Literature

“…These 17 cases are listed in ►Table 1. 4,[11][12][13][14][15][16][17][18][19][20][21][22] In 10 cases, aneurysm formation was associated with hemorrhagic complications. In detail, one patient presented with subarachnoid hemorrhage (SAH), 5 patients with intracerebral hemorrhage (ICH), and two patients with acute subdural hematoma (SDH).…”

“…3,[6][7][8][9][10][11] Although EC-IC bypass surgery using a STA low-flow donor graft usually carries a low procedural morbidity, aneurysm formation at the anastomosis site has been observed. 4,[12][13][14] Up to date there are 17 reported cases of aneurysm formation after EC-IC bypass surgery. This report describes the case of aneurysm formation at the anastomosis site, which was diagnosed incidentally 2 years postoperatively upon routine follow-up examinations for a contralateral common carotid artery (CCA) stenosis.…”