{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:02:46Z","timestamp":1786125766380,"version":"build-2736575974"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T00:00:00Z","timestamp":1591574400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Large dolichoectatic aneurysms of middle cerebral artery (MCA) trifurcations are rare and often require trapping and revascularization of the region with a bypass.\n                    <jats:sup>1-9<\/jats:sup>\n                    This video describes the treatment of an MCA trifurcation aneurysm by clip trapping and double-barrel superficial temporal artery (STA) to M2-MCA bypass followed by M2-M2 end-to-end reimplantation to create a middle communicating artery (MCoA). The patient, a 60-yr-old woman, presented with headache, a history of smoking, and a family history of ruptured aneurysms. Angiography demonstrated a 1.7-cm dolichoectatic aneurysm of the MCA trifurcation. While the natural history of these lesions is unclear, the aneurysm size and family history of aneurysmal subarachnoid hemorrhage were factors in proceeding with treatment. Informed written consent was obtained from the patient and her family.\n                  <\/jats:p>\n                  <jats:p>\u2003The STA branches were harvested microsurgically, a pterional craniotomy was performed, and the aneurysm was exposed through a transsylvian approach. The two STA branches were anastomosed end-to-side to the middle and inferior trunks of the MCA. Due to the significant mismatch between the donor and recipient vessel calibers, we were concerned that the donors might provide insufficient flow in isolation. Therefore, we decided to transect both M2 trunks from the aneurysm, proximal to the inflow of the bypass, and reimplant them end-to-end. This reimplantation created an MCoA, allowing the two donor arteries to supply the new communication between the inferior and middle trunks, redistributing blood flow through the MCoA according to cerebral demand.<\/jats:p>\n                  <jats:p>\n                    \u2003Bypass patency and aneurysm obliteration were confirmed on postoperative angiography. At the 6-mo follow-up, the patient's modified Rankin Scale (mRS) score was 0. The MCoA is a novel construct that, like natural communicating arteries, redistributes flow in response to shifting demand, without the need for additional ischemia time during the bypass.\n                    <jats:italic toggle=\"yes\">Used with permission from Barrow Neurological Institute, Phoenix, Arizona.<\/jats:italic>\n                  <\/jats:p>","DOI":"10.1093\/ons\/opaa159","type":"journal-article","created":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T13:50:06Z","timestamp":1591624206000},"page":"E521-E522","source":"Crossref","is-referenced-by-count":5,"title":["Double-Barrel Superficial Temporal Artery-M2 Middle Cerebral Artery Bypass and Creation of a Middle Communicating Artery via M2-M2 End-to-End Reimplantation for Trapping of a Dolichoectatic Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video"],"prefix":"10.1227","volume":"19","author":[{"given":"Joshua S","family":"Catapano","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio A","family":"Frisoli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan S","family":"Cadigan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dara S","family":"Farhadi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candice L","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8020-6388","authenticated-orcid":false,"given":"Michael T","family":"Lawton","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,11]]},"reference":[{"issue":"3","key":"bib1-20231031","doi-asserted-by":"crossref","first-page":"463","DOI":"10.3171\/2016.7.JNS16772","article-title":"Bypass surgery for complex middle cerebral artery aneurysms: an algorithmic approach to revascularization","volume":"127","author":"Tayebi Meybodi","year":"2017","journal-title":"J Neurosurg"},{"issue":"2","key":"bib2-20231031","doi-asserted-by":"crossref","first-page":"398","DOI":"10.3171\/2013.10.JNS13738","article-title":"Bypass surgery for complex middle cerebral artery aneurysms: impact of the exact location in the MCA tree","volume":"120","author":"Kivipelto","year":"2014","journal-title":"J Neurosurg"},{"issue":"3","key":"bib3-20231031","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/BF01743477","article-title":"Extracranial-intracranial (EC\/IC) bypass in the treatment of giant intracranial aneurysms","volume":"5","author":"Peerless","year":"1982","journal-title":"Neurosurg Rev"},{"issue":"3","key":"bib4-20231031","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1227\/NEU.0b013e3182804381","article-title":"Extracranial-intracranial bypass and vessel occlusion for the treatment of unclippable giant middle cerebral artery 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aneurysms","volume":"111","author":"Seo","year":"2009","journal-title":"Clin Neurol Neurosurg"},{"issue":"6 Suppl","key":"bib8-20231031","first-page":"121","article-title":"Management of giant middle cerebral artery aneurysms with incorporated branches: partial endovascular coiling or combined extracranial-intracranial bypass\u2014a team approach","volume":"65","author":"Shi","year":"2009","journal-title":"Neurosurgery"},{"issue":"3","key":"bib9-20231031","doi-asserted-by":"crossref","first-page":"434","DOI":"10.5603\/FM.a2017.0112","article-title":"Middle cerebral artery anatomical variations and aneurysms: a retrospective study based on computed tomography angiography findings","volume":"77","author":"Brzegowy","year":"2018","journal-title":"Folia Morphol"}],"container-title":["Operative 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