This patient was an 11 year-old who presented with sudden onset of left-sided weakness. Her imaging showed a lesion on the right side of her brain with associated right sided infarcts. Her evaluation included an MRI and then an angiogram. The angiogram revealed a giant fusiform aneurysm of the middle cerebral artery (MCA).
A giant aneurysm is one that is over 2.5 cm in size. Giant fusiform aneurysms are a rare cerebrovascular pathology, especially in the pediatric population. They represent only approximately 5% of aneurysms.
Treatment of these giant aneurysms is very complicated. The standard treatment options of surgical clip ligation or endovascular coil occlusion are not possible. Though the entire artery is abnormal, it is still functioning to deliver blood to the brain. So, any treatment option must eliminate the aneurysm while still allowing blood to reach the brain distal to the aneurysm.
The main approach has been to trap the aneurysm by closing its inflow and its outflow, then to perform a bypass procedure by sewing another artery to the middle cerebral artery distal to the aneurysm to restore blood flow.
We discussed the options with her family and they agreed to proceed with the trapping and bypass procedure. We elected to use the superficial temporal artery as a donor vessel to sew to the middle cerebral artery, which is called STA-MCA bypass.
She underwent a successful trapping and STA-MCA bypass, and has recovered a significant amount of the function on the left side that was lost because of her stroke. She is now back to her regular life.