Three-year-old patient with giant MCA aneurysm treated by trapping–resection plus STA–MCA bypass. Case report

Abstract

Intracranial aneurysm in the pediatric population is very rare; the prevalence has been reported from 0.5% to 4.6% [1–3]. This pathology is completely different from aneurysms in adults: gender predominance; location of aneurysm; incidence of spontaneous thrombosis; incidence of giant, dissecting, and fusiform aneurysm; and rate of subarachnoid hemorrhage, among others [4]. Different multidisciplinary approaches have been used, ranging from conservative follow-up to the most complex microsurgical and endovascular treatments. In the microsurgical group, there are different alternatives, direct clipping and reconstruction or trapping with bypass from extracranial–intracranial (EC–IC) or intracranial–intracranial (IC–IC) types. For the middle cerebral artery aneurysms, the revascularization is an excellent option, especially for the giant lesions in which the reconstruction is not an option. Even more, if we analyze this subject, the overall complication rate of EC–IC procedures is very low, and the 10-year patency rate is as high as 73% [5]. Different types of graft used in children have been reported for EC–IC bypasses with vein graft [5], with radial artery graft [2], and superficial temporal artery (STA) [2, 6]. In the pediatric group, the youngest patient previously reported with an EC–IC bypass with STA–middle cerebral artery (MCA) for a MCA aneurysm had 11 years [6]. We present our case report as the youngest patient ever treated with a combination of trapping with a successful STA–MCA bypass in a giant MCA aneurysm.