Rapid Development of an Aneurysm at the Anastomotic Site of a Superficial Temporal Artery to Middle Cerebral Artery Bypass

Case Report and Literature Review

Matthew Bryan Potts*, Craig Michael Horbinski, Babak S Jahromi

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Direct extracranial to intracranial (EC-IC) bypass is a valuable treatment option for symptomatic occlusive cerebrovascular disease and complex intracranial aneurysms. Aneurysm formation at or near the anastomotic site is a rarely reported phenomenon, and the pathophysiology and appropriate management of such de novo aneurysms are not clear. Case Description: Here we present the case of a superficial temporal to middle cerebral artery (STA-MCA) anastomosis that was complicated by aneurysm formation at the anastomotic site. This was treated with microsurgical clipping with preservation of the bypass. Pathologic analysis of the lesion was consistent with a pseudoaneurysm. We provide a literature review of this phenomenon, which is most often associated with low-flow STA-MCA bypasses, including review of the pathologic findings associated with it. Conclusion: Pseudoaneurysm formation at the site of an EC-IC bypass is a rare phenomenon that should be recognized and treated to prevent further growth and rupture.

Original languageEnglish (US)
Pages (from-to)314-319
Number of pages6
JournalWorld neurosurgery
Volume128
DOIs
StatePublished - Aug 1 2019

Fingerprint

Temporal Arteries
Middle Cerebral Artery
Aneurysm
False Aneurysm
Cerebrovascular Disorders
Intracranial Aneurysm
Rupture
Growth

Keywords

  • Anastomosis
  • Aneurysm
  • Middle cerebral artery
  • Pseudoaneurysm
  • Stroke
  • Superficial temporal artery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

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title = "Rapid Development of an Aneurysm at the Anastomotic Site of a Superficial Temporal Artery to Middle Cerebral Artery Bypass: Case Report and Literature Review",
abstract = "Background: Direct extracranial to intracranial (EC-IC) bypass is a valuable treatment option for symptomatic occlusive cerebrovascular disease and complex intracranial aneurysms. Aneurysm formation at or near the anastomotic site is a rarely reported phenomenon, and the pathophysiology and appropriate management of such de novo aneurysms are not clear. Case Description: Here we present the case of a superficial temporal to middle cerebral artery (STA-MCA) anastomosis that was complicated by aneurysm formation at the anastomotic site. This was treated with microsurgical clipping with preservation of the bypass. Pathologic analysis of the lesion was consistent with a pseudoaneurysm. We provide a literature review of this phenomenon, which is most often associated with low-flow STA-MCA bypasses, including review of the pathologic findings associated with it. Conclusion: Pseudoaneurysm formation at the site of an EC-IC bypass is a rare phenomenon that should be recognized and treated to prevent further growth and rupture.",
keywords = "Anastomosis, Aneurysm, Middle cerebral artery, Pseudoaneurysm, Stroke, Superficial temporal artery",
author = "Potts, {Matthew Bryan} and Horbinski, {Craig Michael} and Jahromi, {Babak S}",
year = "2019",
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doi = "10.1016/j.wneu.2019.05.108",
language = "English (US)",
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journal = "World Neurosurgery",
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publisher = "Elsevier Inc.",

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T2 - Case Report and Literature Review

AU - Potts, Matthew Bryan

AU - Horbinski, Craig Michael

AU - Jahromi, Babak S

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Background: Direct extracranial to intracranial (EC-IC) bypass is a valuable treatment option for symptomatic occlusive cerebrovascular disease and complex intracranial aneurysms. Aneurysm formation at or near the anastomotic site is a rarely reported phenomenon, and the pathophysiology and appropriate management of such de novo aneurysms are not clear. Case Description: Here we present the case of a superficial temporal to middle cerebral artery (STA-MCA) anastomosis that was complicated by aneurysm formation at the anastomotic site. This was treated with microsurgical clipping with preservation of the bypass. Pathologic analysis of the lesion was consistent with a pseudoaneurysm. We provide a literature review of this phenomenon, which is most often associated with low-flow STA-MCA bypasses, including review of the pathologic findings associated with it. Conclusion: Pseudoaneurysm formation at the site of an EC-IC bypass is a rare phenomenon that should be recognized and treated to prevent further growth and rupture.

AB - Background: Direct extracranial to intracranial (EC-IC) bypass is a valuable treatment option for symptomatic occlusive cerebrovascular disease and complex intracranial aneurysms. Aneurysm formation at or near the anastomotic site is a rarely reported phenomenon, and the pathophysiology and appropriate management of such de novo aneurysms are not clear. Case Description: Here we present the case of a superficial temporal to middle cerebral artery (STA-MCA) anastomosis that was complicated by aneurysm formation at the anastomotic site. This was treated with microsurgical clipping with preservation of the bypass. Pathologic analysis of the lesion was consistent with a pseudoaneurysm. We provide a literature review of this phenomenon, which is most often associated with low-flow STA-MCA bypasses, including review of the pathologic findings associated with it. Conclusion: Pseudoaneurysm formation at the site of an EC-IC bypass is a rare phenomenon that should be recognized and treated to prevent further growth and rupture.

KW - Anastomosis

KW - Aneurysm

KW - Middle cerebral artery

KW - Pseudoaneurysm

KW - Stroke

KW - Superficial temporal artery

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