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Reconstruction of both M2 blood flow with a “Y” fashion anastomosis after excision of a large M1 bifurcation aneurysm: advantages and challenges

  • How I Do It -- Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

Middle cerebral artery (MCA) M1 aneurysms with M2 branches originating from the aneurysm neck are difficult to treat because of blood flow reconstruction method selection, graft blood volume matching and various anastomoses.

Method

We report a case of MCA M1 bifurcation aneurysm resection and reconstruction of the bifurcation using “Y” fashion anastomosis. Intraoperative DSA showed anastomotic stoma patency. This patient suffered transient left temporal ischemia and recovered well with a modified Rankin scale of 0 at discharge.

Conclusion

This case demonstrates the application of “Y” fashion anastomosis after the excision of a large M1 bifurcation aneurysm. This bifurcation reconstruction method showed advantages and challenges in specific situations.

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Data availability

The data that support the findings of this study are openly available.

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Acknowledgements

The authors thank Tianming Qiu and Zongze Li for surgery participants, Yingtao Liu for imaging processing, Yang Xiao for intraoperative electrophysiological monitoring support and Junou Tang for illustration drawing.

Funding

This study was supported by the Clinical Research Plan of SHDC (No. SHDC2020CR2034B to WZ), Shanghai Municipal Science and Technology Major Project (No. 2018SHZDZX01) and ZJ Lab, and CAMS Innovation Fund for Medical Sciences (CIFMS, 2019-I2 M-5–008).

Author information

Author notes

  1. Peixi Liu and Yuan Shi contributed to this article equally.

Authors and Affiliations

  1. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China

    Peixi Liu, Yuan Shi, Peiliang Li & Wei Zhu

  2. National Center for Neurological Disorders, Shanghai, 200040, China

    Peixi Liu, Yuan Shi, Peiliang Li & Wei Zhu

  3. Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China

    Peixi Liu, Yuan Shi, Peiliang Li & Wei Zhu

  4. Neurosurgical Institute of Fudan University, Shanghai, 200040, China

    Peixi Liu, Yuan Shi, Peiliang Li & Wei Zhu

  5. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China

    Peixi Liu, Yuan Shi, Peiliang Li & Wei Zhu

Authors
  1. Peixi Liu
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  2. Yuan Shi
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  3. Peiliang Li
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  4. Wei Zhu
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Contributions

Peixi Liu: participants in surgery, conception and design of the study, provision of study material, collection and/or assembly of data, manuscript writing, and final approval of the manuscript.

Yuan Shi: literature collection and collation.

Peiliang Li: participants in surgery, conception, and design of the study.

Wei Zhu: conception and design of the study and revision and final approval of the manuscript.

Corresponding author

Correspondence to Wei Zhu.

Ethics declarations

Informed consent

The patient gave approval for this publication.

Conflict of interest

The authors declare no competing interests.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Huashan Hospital Institutional Review Board (HIRB), Fudan University, Shanghai, China.

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Key points

1. Preoperative high-resolution MRI helps operators assess the possibility of direct clipping.

2. Bypass is the first choice for bifurcation aneurysms involving the M1 and M2 branches or with severe atherosclerosis or intramural thrombus.

3. Plenty blood volume and matched anastomosis caliber should be taken into consideration in bypass surgery.

4. Two or more surgical strategies should be set before operation.

5. RA and STA branches should be preserved for bypass.

6. Skillful anastomosis under the narrow corridor is needed to reduce temporary occlusion time and MCA feeding area ischemia time.

7. SEP and MEP monitoring are quick measures to determine temporary occlusion tolerance and blood flow changes.

8. Postoperative volume expansion therapy is needed.

9. Postoperative MRI, especially DWI, shows ischemic complications.

10. At least one DSA follow-up is required after discharge.

This article is part of the Topical Collection on Vascular Neurosurgery—Aneurysm

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Liu, P., Shi, Y., Li, P. et al. Reconstruction of both M2 blood flow with a “Y” fashion anastomosis after excision of a large M1 bifurcation aneurysm: advantages and challenges. Acta Neurochir 165, 483–488 (2023). https://doi.org/10.1007/s00701-022-05484-4

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  • DOI: https://doi.org/10.1007/s00701-022-05484-4

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