Early Resolution of Abnormal Vascular Networks After Superficial Temporal Artery to Middle Cerebral Artery (STA-MCA) Bypass Surgery for Twig-Like Middle Cerebral Artery With Intracerebral Hemorrhage: A Case Report.

The twig-like middle cerebral artery (T-MCA) is a rare condition characterized by unilateral middle cerebral artery (MCA) occlusion and abnormal vascular networks, resembling Moyamoya Disease (MMD). While some reports mention bypass surgery for T-MCA, akin to MMD, there is no established treatment method. Previous reports highlight the efficacy of revascularization procedures in preventing recurrent strokes in T-MCA patients, but there is limited data on its usefulness for cases with intracerebral hemorrhagic onset. We present the case of a 37-year-old man in whom bypass surgery for T-MCA with intracerebral hemorrhage was successful, and the periventricular anastomosis, which could have caused the hemorrhage, was resolved early. The patient showed improvement after surgery, and the subsequent MRI, seven days after surgery, confirmed the disappearance of the periventricular anastomosis. Remarkably, no stroke recurrence was observed throughout the 15-month follow-up. This case suggests the usefulness of bypass surgery for T-MCA with hemorrhagic onset, especially when periventricular anastomosis is involved. Further research to determine the optimal timing and treatment approaches for such cases is required.