A double-barrel superficial temporal artery-to-superior cerebellar artery (STA-SCA) and STA-to-posterior cerebral artery (STA-PCA) bypass for revascularization of the basilar apex.

Basilar apex aneurysms are challenging lesions for both microsurgical and endovascular therapy. In patients in whom direct clipping and coil embolization are not options, cerebral revascularization and occlusion of the basilar artery is a possible treatment strategy. We report a patient with a large basilar apex aneurysm treated by double-barrel anastomoses of the superficial temporal artery to the superior cerebellar artery (STA-SCA) and the STA to the posterior cerebral artery (STA-PCA) followed by occlusion of the basilar artery below the SCAs. A double-barrel bypass augments blood flow to the brainstem. We report a novel bypass option for augmenting blood flow to the basilar apex and brainstem.