PMC8818776_01
Preoperative and postoperative comparison. (A,B) Preoperative DSA (A, frontal view; B, anterior upper view) showing an aneurysm at the bifurcation of M1, a small outflow path (the white arrow) and a larger outflow path (the yellow arrow) at the lateral side of the aneurysm; (C) Preoperative CTA 3D reconstruction; (D,E,F) Postoperative DSA and CTA showed that the IMX-RA-M2 bypass artery was patent (two yellow arrows indicate the RAG anastomosis), the aneurysm disappeared, and the distal artery of MCA was clearly developed (comparing C and F).
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F1
The inflow path of the aneurysm was in the front of M1 bifurcation, and one outflow artery branch was seen to originate from the aneurysm, and another small artery attached to the aneurysm was suspected to be another outflow artery, as shown in Figures 1A,B. The M1 segment of the right MCA, the aneurysm, anterior cerebral artery, and internal carotid artery were exposed (Figure 1A). The exploration showed that two branches of the MCA emanated from the aneurysm, one of which was larger and emitted two branching arteries, confirming the preoperative conjecture (comparing Figures 3A,B with Figure 1B).
Preoperative examination and surgical design. (A) Preoperative CTA showed that the right internal maxillary artery was located deep inside the lateral wing muscle. (B) Preoperative 3D display of bone window, aneurysm, and internal maxillary artery, the black arrow is the internal maxillary artery; (C) Schematic diagram of bypass surgery.
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F2
The relevant preoperative examination and operation diagram is shown in Figure 2.
Intraoperative images. (A) Aneurysm inflow artery and outflow artery were explored. Two outflow paths were affirmed, location of STA-M2 and RA-M2 anastomosis were indicated by white and yellow arrows; (B) Indocyanine green video angiography after aneurysm exploration; (C) Arteries conditions after end-to-side anastomosis of intracranial parts, the white arrow indicate STA-M2 anastomosis, and the yellow arrow indicate RA-M2 anastomosis; (D) The yellow arrow indicate RA-IMA end-to-side anastomosis; (E,F) The aneurysm was isolated after the completion of the bypass, and indocyanine green video angiography showed that the aneurysm disappeared and the reconstructed arteries were patent.
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F3
MCA supplying area, the distal trunk and branches of the MCA were also well-developed, as shown in Figures 3E,F. MRI indicated a small cerebral infarction in the external capsule area, but the child had no obvious neurological dysfunction.
PMC8818776_02
Intraoperative images. (A) Aneurysm inflow artery and outflow artery were explored. Two outflow paths were affirmed, location of STA-M2 and RA-M2 anastomosis were indicated by white and yellow arrows; (B) Indocyanine green video angiography after aneurysm exploration; (C) Arteries conditions after end-to-side anastomosis of intracranial parts, the white arrow indicate STA-M2 anastomosis, and the yellow arrow indicate RA-M2 anastomosis; (D) The yellow arrow indicate RA-IMA end-to-side anastomosis; (E,F) The aneurysm was isolated after the completion of the bypass, and indocyanine green video angiography showed that the aneurysm disappeared and the reconstructed arteries were patent.
fsurg-08-773371-g0003.jpg
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F3
MCA supplying area, the distal trunk and branches of the MCA were also well-developed, as shown in Figures 3E,F. MRI indicated a small cerebral infarction in the external capsule area, but the child had no obvious neurological dysfunction.
PMC8818776_03