{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:03:43Z","timestamp":1786125823412,"version":"build-2736575974"},"reference-count":4,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2021,1,13]],"date-time":"2021-01-13T00:00:00Z","timestamp":1610496000000},"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":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Cerebral revascularization is the treatment of choice for select complex intracranial aneurysms unamenable to traditional approaches.\n                    <jats:sup>1<\/jats:sup>\n                    Complex middle cerebral artery (MCA) bifurcation aneurysms can include the origins of 1 or both M2 branches and may benefit from a revascularization strategy.\n                    <jats:sup>2,3<\/jats:sup>\n                    A novel 3-vessel anastomosis technique combining side-to-side and end-to-side anastomoses, allowing for bihemispheric anterior cerebral artery revascularization, was recently reported.\n                    <jats:sup>4<\/jats:sup>\n                  <\/jats:p>\n                  <jats:p>This 2-dimensional operative video presents the case of a 73-yr-old woman who presented as a Hunt-Hess grade 4 subarachnoid hemorrhage due to the rupture of a large right MCA bifurcation aneurysm. The aneurysm incorporated the origins of the frontal and temporal M2 branches and was deemed unfavorable for endovascular treatment. A strategy using a high-flow bypass from the external carotid artery to the MCA with a saphenous vein (SV) graft was planned to revascularize both M2 branches simultaneously, followed by clip-trapping of the aneurysm. Intraoperatively, the back walls of both M2 segments distal to the aneurysm were connected with a standard running suture, and the SV graft was then attached to the side-to-side construct in an end-to-side fashion. Catheter angiograms on postoperative days 1 and 6 demonstrated sustained patency of the anastomosis and good filling through the bypass. The patient's clinical course was complicated by vasospasm-related right MCA territory strokes, resulting in left-sided weakness, which significantly improved upon 3-mo follow-up with no new ischemia.<\/jats:p>\n                  <jats:p>The patient consented for inclusion in a prospective Institutional Review Board (IRB)-approved database from which this IRB-approved retrospective report was created.<\/jats:p>","DOI":"10.1093\/ons\/opaa426","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T06:54:16Z","timestamp":1610607256000},"page":"E359-E360","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["External Carotid Artery-to-Middle Cerebral Artery Bypass Using a Saphenous Vein Graft With 3-Vessel Anastomosis for the Treatment of a Large, Ruptured Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video"],"prefix":"10.1227","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0927-5719","authenticated-orcid":false,"given":"Kristine","family":"Ravina","sequence":"first","affiliation":[{"name":"Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Bakhsheshian","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph N","family":"Carey","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J","family":"Russin","sequence":"additional","affiliation":[{"name":"Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California"},{"name":"Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,5]]},"reference":[{"issue":"5","key":"bib1-20251027","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1227\/NEU.0000000000000312","article-title":"Revascularization and aneurysm surgery: techniques, indications, and outcomes in the endovascular era","volume":"74","author":"Kalani","year":"2014","journal-title":"Neurosurgery"},{"issue":"5","key":"bib2-20251027","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.surneu.2006.11.056","article-title":"Microneurosurgical management of middle cerebral artery bifurcation aneurysms","volume":"67","author":"Dashti","year":"2007","journal-title":"Surg Neurol"},{"issue":"3","key":"bib3-20251027","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":"3","key":"bib4-20251027","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1093\/ons\/opz401","article-title":"Three-vessel anastomosis for direct bihemispheric cerebral revascularization","volume":"19","author":"Ravina","year":"2020","journal-title":"Oper Neurosurg"}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/article-pdf\/20\/5\/E359\/37041583\/opaa426.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opaa426","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:02:06Z","timestamp":1786122126000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opaa426"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,13]]},"references-count":4,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opaa426","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,13]]},"assertion":[{"value":"2020-06-24","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-09","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}