'Y'-Shaped Palmar Common Digital Artery Interposition Bypass in the Treatment of an Infantile M2 Large Aneurysm and Literature Review

Abstract

Objective: Both craniotomy and interventional embolization are difficult and risky to treat complex middle cerebral artery (MCA) aneurysms in infants. Trapping with revascularization is a therapeutic option for giant aneurysms that cannot be clipped or coiled alone.

Method: We describe a technical method using revascularization with a natural Y-shaped palmar common digital artery interposition graft that provides a normal variation for a complex MCA aneurysm in an infant with intracerebral hemorrhage at 37 days of age. Conservative treatment was performed at that time. Seven months later, the patient was re-admitted to the hospital and was confirmed a large aneurysm in the M2 segment of the right MCA by cerebral angiography. A natural artery palmar common digital artery Y-graft was used as the graft and anastomosed to the M2 and both M3 trunks.

Result: The symptoms improved after surgery, and the mRS score of the patient was 1 after 5 years of follow-up.

Conclusion: The palmar common digital artery can be an option for intracranial revascularization bypass in complex intracranial aneurysms.

Keywords: Aneurysm; Bypass; Infant; Infantile intracranial aneurysms; Middle cerebral artery; Palmar common digital artery; Y-shaped.