Internal maxillary artery to middle cerebral artery bypass for a complex recurrent middle cerebral artery aneurysm: case report and technical considerations

Abstract

We report the case of a 41-year-old male who presented with an enlarging aneurysm neck one year after clipping. The patient underwent an IMAX-MCA bypass followed by endovascular coil occlusion of the aneurysm neck incorporating an MCA branch origin. To our knowledge, this case represents the first documented IMAX-MCA bypass from a European centre. This case demonstrates that for neurosurgeons experienced in EC-IC bypass surgery, IMAX-MCA bypass is feasible and can be performed safely as long as careful attention is paid to anatomical landmarks and vascular anastomosis principles. CTA-based neuronavigation and micro-Doppler are essential intraoperative tools for identifying the IMAX.

Keywords:

• Aneurysm
• extracranial-intracranial bypass
• high flow bypass
• IMAX-MCA
• revascularisation

Disclosure statement

No potential conflict of interest was reported by the author(s).

Informed consent

The patient has consented to the submission of the case report for submission to the journal.