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Treatment of Giant and Large Fusiform Middle Cerebral Artery Aneurysms With Excision and Interposition Radial Artery Graft in a 4-Year-Old Child: Case Report

Mrak, Goran MD, PhD*; Paladino, Josip MD, PhD*; Stambolija, Vasilije MD*; Nemir, Jakob MD*; Sekhar, Laligam N. MD, FACS

doi: 10.1227/NEU.0000000000000168
Technical Case Report

BACKGROUND AND IMPORTANCE: We report an unusual case of complex giant and large fusiform aneurysms not amenable for clipping or coiling in a 4-year-old child managed with aneurysm resection and radial artery interposition graft.

CLINICAL PRESENTATION: A 4-year-old child presented with repeated severe headache and vomiting. Computed tomography, magnetic resonance imaging, and magnetic resonance angiography and digital subtraction angiography showed a giant fusiform aneurysm on the right middle cerebral artery (MCA). Because of the complex shape, endovascular treatment or clip reconstruction was not possible, and a bypass procedure was planned. Right frontotemporal craniotomy and orbitotomy was performed. Two aneurysms involving the M1 segment of the MCA were found in line, 1 giant, and the other large in size. The aneurysms were resected and treated with short radial artery interposition graft, which was narrower than the proximal or distal MCA. The child recovered normally, and the bypass was patent after 1 year.

CONCLUSION: Large fusiform MCA aneurysms may be difficult to treat, but there are treatment options that include a bypass procedure. Resection and short interposition radial artery graft is an excellent but rare treatment option in a very young child. This was a very successful treatment in this child.

ABBREVIATIONS: ICA, internal carotid artery

MCA, middle cerebral artery

RA, radial artery

RAG, radial artery graft

STA, superficial temporal artery

*Department of Neurosurgery, Clinical Hospital Centre Zagreb- Rebro, School of Medicine Zagreb, Zagreb, Croatia;

Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, Washington

Correspondence: Goran Mrak, MD, PhD, Department of Neurosurgery, Clinical Hospital Centre Zagreb- Rebro, School of Medicine Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia. E-mail:

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Received April 04, 2013

Accepted September 06, 2013

© 2014 by Lippincott Williams & Wilkins, Inc.
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