Three-year-old patient with giant MCA aneurysm treated by trapping–resection plus STA–MCA bypass. Case report

Abstract

Artículo de publicación ISIIntracranial aneurysm in the pediatric population is very rare; the prevalence has been reported from 0.5% to 4.6% [1–3]. This pathology is completely different from aneurysms in adults: gender predominance; location of aneurysm; incidence of spontaneous thrombosis; incidence of giant, dissecting, and fusiform aneurysm; and rate of subarachnoid hemorrhage, among others [4]. Different multidisciplinary approaches have been used, ranging from conservative follow-up to the most complex microsurgical and endovascular treatments. In the microsurgical group, there are different alternatives, direct clipping and reconstruction or trapping with bypass from extracranial–intracranial (EC–IC) or intracranial–intracranial (IC–IC) types. For the middle cerebral artery aneurysms, the revascularization is an excellent option, especially for the giant lesions in which the reconstruction is not an option. Even more, if we analyze this subject, the overall complication rate of EC–IC procedures is very low, and the 10-year patency rate is as high as 73% [5]. Different types of graft used in children have been reported for EC–IC bypasses with vein graft [5], with radial artery graft [2], and superficial temporal artery (STA) [2, 6]. In the pediatric group, the youngest patient previously reported with an EC–IC bypass with STA–middle cerebral artery (MCA) for a MCA aneurysm had 11 years [6]. We present our case report as the youngest patient ever treated with a combination of trapping with a successful STA–MCA bypass in a giant MCA aneurysm

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

“…Although we use preoperative balloon-test occlusion and routinely monitor patients intraoperatively with somatosensory and motor evoked potentials, these tests result in significant falsenegative rates and inconsistencies, and we prefer not to rely on them when deciding on the type of bypass to use. 15,17,25,48…”

“…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.…”

Combining Internal Carotid Artery Occlusion with Intermediate-Flow Bypass for Treating Large-Giant Cavernous Sinus Segment Aneurysms: Case Report and Review of Literature

“…However, few reports have discussed the treatment and experiences of High fl ow bypass surgery in CS ICA aneurysm. 4,10,17 Our case showed cranial nerve compression symptoms with higher expectations for improvement of her symptoms. Therefore, interventional embolization treatment was not considered as the preferred option.…”

A child who presented with cerebral infarction: Clipping combined with bypass surgery of a thrombosed giant aneurysm

“…In children, both vein grafts and STA were reported to be used for EC-IC bypass. [5] Furthermore, revascularization procedure is expected to reduce the risk of late ischemic stroke. [9] In this case, different surgical approaches were considered preoperatively to achieve the goals of complete ligation of aneurysm and preservation of distal blood flow.…”

“…In children, both vein grafts and STA were reported to be used for EC-IC bypass. [ 5 ] Furthermore, revascularization procedure is expected to reduce the risk of late ischemic stroke. [ 9 ]…”