High-flow bypass and tandem microsurgical-endovascular occlusion of recurrent proximal middle cerebral artery aneurysms in a pediatric patient

Document Type

Article

Abstract

The authors report the case of a 7-year-old boy with headaches, in whom CT angiography showed multiple intracranial aneurysms from the terminus region of the right internal carotid artery through the proximal right middle cerebral artery (MCA). Initially, the patient underwent clip reconstruction of the M(1) segment. Multiple microsurgical and endovascular treatments were required because the largest of these aneurysms recurred several times over the next 1.5 years. The first recurrence was treated with stent coiling and the second by microsurgical occlusion of the MCA combined with the use of a radial artery graft in a common carotid artery-to-MCA bypass. The aneurysm again recurred and was treated by proximal coil occlusion 15 months after the first treatment session. At a 7.5-year follow-up examination, the aneurysms remained occluded. This case highlights the benefit of combined endovascular and microsurgical techniques in the treatment of a complex and unusual case of proximal MCA aneurysmal disease. The patient, now 15 years old, is neurologically intact and able to participate in all activities.

Medical Subject Headings

Child; Endovascular Procedures (methods); Humans; Intracranial Aneurysm (surgery); Male; Microsurgery; Recurrence; Stents

Publication Date

11-1-2012

Publication Title

Journal of neurosurgery. Pediatrics

E-ISSN

1933-0715

Volume

10

Issue

5

First Page

365

Last Page

9

PubMed ID

22938076

Digital Object Identifier (DOI)

10.3171/2012.8.PEDS12101

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