Pterional Craniotomy for Anterior Temporal Artery to Middle Cerebral Artery Bypass: 2-Dimensional Operative Video

Broad-based aneurysms of the middle cerebral artery M1 bifurcation usually involve aneurysmal inclusion of an M2 vessel wall within the neck. This necessitates a consideration of performing a bypass to preserve the patency of distal perfusion. The patient in this video is a 17-yr-old man who presented after experiencing a small stroke and was found to have a partially thrombosed giant middle cerebral artery M1 bifurcation aneurysm with an M2 branch arising from the aneurysm. To maintain the perfusion of the M2 brain, the anterior temporal artery was used to perform a side-to-side anastomosis with the M2 brain at risk. A distal clip was determined to be not necessary for aneurysm occlusion because the aneurysm was almost completely thrombosed before the operation and the bypass flow was anticipated to be sufficient to facilitate complete thrombosis. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.