{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:03:59Z","timestamp":1786125839902,"version":"build-2736575974"},"reference-count":7,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2021,8,12]],"date-time":"2021-08-12T00:00:00Z","timestamp":1628726400000},"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"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Fusiform middle cerebral artery (MCA) aneurysms that require treatment can often necessitate complex endovascular or microsurgical treatment. We present a case of a 25-yr-old female with an incidentally discovered left 14-mm fusiform MCA aneurysm incorporating the frontal MCA trunk origin in its dome. The location and anatomy were not favorable for endovascular treatment with flow diversion.<\/jats:p>\n                  <jats:p>\u2003The patient was offered continued observation or microsurgical treatment. Direct clipping of this aneurysm was not possible. After a thorough discussion of the risks, benefits, indications, and natural history of the lesion, the patient desired to have the aneurysm treated given her young age, location, size of the aneurysm, and the significant clinical experience of the treating team in bypass surgery.<\/jats:p>\n                  <jats:p>\n                    \u2003The patient underwent superficial temporal artery to frontal M2 (STA-FM2) direct bypass for flow replacement followed by microsurgical trapping and clip ligation. The patient was maintained on antiplatelet therapy preoperatively and postoperatively. The patient had a transient aphasia and mild right upper extremity weakness (4\/5) in the immediate postoperative period, which fully recovered by the time of patient discharge. The case presentation, surgical anatomy, technique, and postoperative course and outcome are reviewed. The different strategies for bypass and clip ligation are reviewed with particular focus on the anatomic constraints for each bypass configuration. The outcomes of bypass surgery for MCA aneurysms are reviewed.\n                    <jats:sup>1-7<\/jats:sup>\n                    The patient gave verbal consent for participating in the procedure, surgical video, and publication of their image.\n                  <\/jats:p>","DOI":"10.1093\/ons\/opab281","type":"journal-article","created":{"date-parts":[[2021,8,12]],"date-time":"2021-08-12T04:02:57Z","timestamp":1628740977000},"page":"E445-E446","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Microsurgical Clipping and Bypass for Fusiform Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video"],"prefix":"10.1227","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4099-089X","authenticated-orcid":false,"given":"Nickalus R","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie H","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques J","family":"Morcos","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,11]]},"reference":[{"issue":"3","key":"bib1-20250821","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 aneurysms","volume":"72","author":"Kalani","year":"2013","journal-title":"Neurosurgery"},{"issue":"2","key":"bib2-20250821","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":"10","key":"bib3-20250821","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1007\/s00701-019-04042-9","article-title":"Bypass surgery of complex middle cerebral artery aneurysms\u2014technical aspects and outcomes","volume":"161","author":"Wessels","year":"2019","journal-title":"Acta Neurochir (Wien)"},{"key":"bib4-20250821","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.wneu.2016.12.007","article-title":"Anterior temporal artery-to-anterior cerebral artery bypass: anatomic feasibility of a novel intracranial-intracranial revascularization technique","volume":"99","author":"Meybodi","year":"2017","journal-title":"World Neurosurg"},{"key":"bib5-20250821","doi-asserted-by":"crossref","first-page":"e272","DOI":"10.1016\/j.wneu.2019.06.059","article-title":"Brain bypass surgery for complex middle cerebral artery aneurysms: evolving techniques, results, and lessons learned","volume":"130","author":"Natarajan","year":"2019","journal-title":"World Neurosurg"},{"issue":"11","key":"bib6-20250821","doi-asserted-by":"crossref","first-page":"3251","DOI":"10.1161\/STROKEAHA.114.006292","article-title":"Natural history and outcome after treatment of unruptured intradural fusiform aneurysms","volume":"45","author":"Sacho","year":"2014","journal-title":"Stroke"},{"issue":"2","key":"bib7-20250821","doi-asserted-by":"crossref","first-page":"228","DOI":"10.3171\/jns.2003.99.2.0228","article-title":"Spontaneous fusiform middle cerebral artery aneurysms: characteristics and a proposed mechanism of formation","volume":"99","author":"Day","year":"2003","journal-title":"J Neurosurg"}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/article-pdf\/21\/5\/E445\/40515104\/opab281.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab281","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:02:43Z","timestamp":1786122163000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab281"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,12]]},"references-count":7,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opab281","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,12]]},"assertion":[{"value":"2020-12-04","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-06-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}