Superficial Temporal Artery to Anterior Cerebral Artery Hemi-bonnet Bypass Using Radial Artery Graft for Prevention of Complications after Surgical Treatment of Partially Thrombosed Large/Giant Anterior Cerebral Artery Aneurysm.

BACKGROUND: Partially thrombosed large/giant aneurysm of the anterior cerebral artery is still challenging because this complex aneurysm requires arterial revascularization in the deep operation field. Therefore, direct neck clipping is often impossible. We describe our experiences with extracranial-intracranial bypass as an insurance bypass prior to clipping of partially thrombosed anterior cerebral artery aneurysms, and discuss the microsurgical technique and strategy.

CLINICAL PRESENTATION: Consecutive, single-surgeon experience with the surgical treatment of partially thrombosed anterior cerebral artery aneurysms was retrospectively reviewed. Three cases of partially thrombosed anterior cerebral artery aneurysms, 2 anterior communicating artery aneurysms, and 1 postcommunicating artery (A2 segment of the anterior cerebral artery) aneurysm, presented as mass effect symptoms from giant aneurysms in 2 patients and incidentally discovered aneurysm in one patient. Superficial temporal artery-radial artery graft-anterior cerebral artery hemi-bonnet bypass was performed as an insurance bypass prior to clipping of the partially thrombosed anterior cerebral artery aneurysms. Complete aneurysm obliteration and bypass patency were demonstrated in all 3 patients. No neurological sequelae occurred.

CONCLUSIONS: Superficial temporal artery-radial artery graft-anterior cerebral artery hemi-bonnet bypass prior to aneurysm dissection can avoid ischemic complication during temporary occlusion and secures permanent revascularization after complete obliteration of partially thrombosed large/giant anterior cerebral artery aneurysm.