One-stage hybrid treatment of a ruptured M1 fusiform aneurysm with double-barrel STA-MCA bypass and endovascular embolization.

Abstract

The management of ruptured, giant, fusiform aneurysms of the M1 segment of the middle cerebral artery (MCA) presents a significant therapeutic challenge. This difficulty is primarily due to their morphology, which lacks a distinct, clippable neck, and the involvement of critical lenticulostriate perforators. We describe a one-stage hybrid strategy that combines surgical revascularization with endovascular embolization. The procedure begins with a double-barrel superficial temporal artery (STA) to MCA bypass for flow replacement, followed by dual-microcatheter coil embolization of the aneurysm and its daughter sac, culminating in parent artery occlusion. For ruptured giant M1 fusiform aneurysms with challenging proximal surgical exposure, a hybrid approach involving revascularization and subsequent parent artery occlusion represents a safe and effective treatment modality. The larger caliber of the STA in adult males allows for high-flow revascularization through a double-barrel bypass.