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

Abstract

This case report describes the de novo aneurysm formation at the anastomosis site 2 years after single-barrel superficial temporal artery to middle cerebral artery bypass surgery. Correct bypass patency and morphology of the anastomosis site was documented intraoperatively and immediately postoperatively by indocyanine green videoangiography and digital subtraction angiography (DSA). Aneurysmatic dilatation at the anastomosis site was observed 2 years postoperatively upon computed tomography angiographic follow-up examination. After repeat DSA, the patient underwent microsurgical reexploration and clip ligation of the aneurysmatic portion of the donor artery. The possible underlying mechanisms are discussed and the current literature is reviewed.

Keywords

bypass surgery - cerebral aneurysm - STA-MCA bypass - ICG videoangiography

• References

• 1 Garrett MC, Komotar RJ, Starke RM , et al. The efficacy of direct extracranial-intracranial bypass in the treatment of symptomatic hemodynamic failure secondary to athero-occlusive disease: a systematic review. Clin Neurol Neurosurg 2009; 111 (4) 319-326
• 2 Gross BA, Du R. STA-MCA bypass. Acta Neurochir (Wien) 2012; 154 (8) 1463-1467
• 3 Newell DW. Superficial temporal artery to middle cerebral artery bypass. Skull Base 2005; 15 (2) 133-141
• 4 Nishimoto T, Yuki K, Sasaki T, Murakami T, Kodama Y, Kurisu K. A ruptured middle cerebral artery aneurysm originating from the site of anastomosis 20 years after extracranial-intracranial bypass for moyamoya disease: case report. Surg Neurol 2005; 64 (3) 261-265 ; discussion 265
• 5 Yasargil MG, Yonekawa Y. Results of microsurgical extra-intracranial arterial bypass in the treatment of cerebral ischemia. Neurosurgery 1977; 1 (1) 22-24
• 6 Vilela MD, Newell DW. Superficial temporal artery to middle cerebral artery bypass: past, present, and future. Neurosurg Focus 2008; 24 (2) E2
• 7 Komotar RJ, Starke RM, Otten ML , et al. The role of indirect extracranial-intracranial bypass in the treatment of symptomatic intracranial atheroocclusive disease. J Neurosurg 2009; 110 (5) 896-904
• 8 Powers WJ, Clarke WR, Grubb Jr RL, Videen TO, Adams Jr HP, Derdeyn CP ; COSS Investigators. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA 2011; 306 (18) 1983-1992
• 9 Hänggi D, Steiger HJ, Vajkoczy P ; Cerebrovascular Section of the European Association of Neurological Surgeons (EANS). EC-IC bypass for stroke: is there a future perspective?. Acta Neurochir (Wien) 2012; 154 (10) 1943-1944
• 10 Amin-Hanjani S, Barker II FG, Charbel FT, Connolly Jr ES, Morcos JJ, Thompson BG ; Cerebrovascular Section of the American Association of Neurological Surgeons; Congress of Neurological Surgeons. Extracranial-intracranial bypass for stroke—is this the end of the line or a bump in the road?. Neurosurgery 2012; 71 (3) 557-561
• 11 Nishizawa S, Yokoyama T, Sugiyama K, Yokota N. Intracerebral hemorrhage from a ruptured pseudoaneurysm after STA-MCA anastomosis—case report. Neurol Med Chir (Tokyo) 2000; 40 (8) 408-412
• 12 Sasaki T, Kodama N, Itokawa H. Aneurysm formation and rupture at the site of anastomosis following bypass surgery. Case report. J Neurosurg 1996; 85 (3) 500-502
• 13 Kohno K, Ueda T, Kadota O, Sakaki S. Subdural hemorrhage caused by de novo aneurysm complicating extracranial-intracranial bypass surgery: case report. Neurosurgery 1996; 38 (5) 1051-1055
• 14 Hokari M, Yasuda H, Iwasaki M , et al. Intracerebral hemorrhage from a ruptured aneurysm at the site of anastomosis 27 years after superficial temporal artery-middle cerebral artery bypass. Neurol Med Chir (Tokyo) 2010; 50 (11) 1012-1014
• 15 Eom KS, Kim DW, Kang SD. Intracerebral hemorrhage caused by rupture of a giant aneurysm complicating superficial temporal artery-middle cerebral artery anastomosis for moyamoya disease. Acta Neurochir (Wien) 2010; 152 (6) 1069-1073 ; discussion 1073
• 16 Leclercq TA, Ambler MW. Fatal subdural bleeding following superficial temporal-middle cerebral artery anastomosis. Case report. J Neurosurg 1980; 52 (3) 392-394
• 17 Lantos G, Fein JM, Knep S. Cortical artery aneurysm formation after extracranial to intracranial bypass surgery. Case report. J Neurosurg 1984; 60 (3) 636-639
• 18 Kurokawa T, Harada K, Ishihara H , et al. De novo aneurysm formation on middle cerebral artery branches adjacent to the anastomotic site of superficial temporal artery-middle cerebral artery bypass surgery in two patients: technical case report. Neurosurgery 2007; 61 (5) (Suppl. 02) E297-E298 ; discussion E298
• 19 Fleischer AS, Faria Jr MA, Hoffmann Jr JC. Pseudoaneurysm complicating superficial temporal artery—middle cerebral artery bypass. Surg Neurol 1979; 12 (4) 305-306
• 20 Parent AD, Smith RR. Traumatic aneurysm complicating EC-IC bypass: successful surgical clipping. Surg Neurol 1981; 15 (3) 229-231
• 21 Morgan M, Besser M, Tuck R. Pseudoaneurysm complicating superficial temporal artery-superior cerebellar artery bypass. Surg Neurol 1986; 26 (3) 277-281
• 22 Fein JM. Bypass induced cerebral aneurysm. Neurol Res 1985; 7 (1) 46-52
• 23 Robertson JH, Robertson JT. The relationship between suture number and quality of anastomoses in microvascular procedures. Surg Neurol 1978; 10 (4) 241-245
• 24 Aoki T, Yoshitomi M, Yamamoto M, Hirohata M, Morioka M. Ruptured de novo aneurysm arising at a site remote from the anastomosis 14 years after superficial temporal artery-middle cerebral artery bypass: a case report. Neurosurgery 2012; 71 (4) E905-E909