{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T13:12:10Z","timestamp":1787404330183,"version":"build-2736575974"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T00:00:00Z","timestamp":1643760000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Recurrent complex middle cerebral artery (MCA) aneurysms after combined clipping and endovascular surgery are challenging, and if conventional techniques are adapted, advanced surgical, endovascular, and a combination of both techniques are often required. For such complex aneurysms, safe and effective straightforward techniques for all neurovascular surgeons are warranted. We describe the details of staged hybrid techniques with straightforward bypass surgery followed by flow diverter deployment in a patient with complex MCA aneurysm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Illustrative Case<\/jats:title><jats:p>A 69-year-old woman presented with left recurrent large MCA aneurysm enlargement 25 years after direct surgery and coil embolization for ruptured aneurysm. The recurrent MCA aneurysm had large and complex morphology and was adhering to the brain tissues. Therefore, it was unsuitable to treat such aneurysm with conventional surgical and endovascular techniques with a high risk of morbidity. We performed (1) M2 ligation following superficial temporal artery-M2 bypass and (2) flow diverter deployment assisted with coil packing in two sessions. Three months after the second session, the aneurysm was completely occluded with endothelialization of the neck. Angiographic findings revealed no recurrence 12 months after the treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Staged hybrid techniques with straightforward bypass surgery followed by flow diverter deployment may be a safe and effective treatment for complex recurrent MCA aneurysms.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.824236","type":"journal-article","created":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T04:47:28Z","timestamp":1643777248000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Staged Hybrid Techniques With Straightforward Bypass Surgery Followed by Flow Diverter Deployment for Complex Recurrent Middle Cerebral Artery Aneurysms"],"prefix":"10.3389","volume":"9","author":[{"given":"Jun","family":"Tanabe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiro","family":"Nakahara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoji","family":"Matsumoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Morioka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiko","family":"Hasebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadayoshi","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichiro","family":"Suyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyonori","family":"Kuwahara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,2,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"239","DOI":"10.3171\/2015.5.JNS142524","article-title":"Risk factors for neurological worsening and symptomatic watershed infarction in internal carotid artery aneurysm treated by extracranial-intracranial bypass using radial artery graft","volume":"125","author":"Matsukawa","year":"2016","journal-title":"J Neurosurg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1227\/00006123-198508000-00004","article-title":"Complications of cerebral revascularization with autogenous vein grafts","volume":"17","author":"Diaz","year":"1985","journal-title":"Neurosurgery."},{"key":"B3","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1227\/00006123-200109000-00023","article-title":"Cerebral revascularization using radial artery grafts for the treatment of complex intracranial aneurysms: Techniques and outcomes for 17 patients","volume":"49","author":"Sekhar","year":"2001","journal-title":"Neurosurgery."},{"key":"B4","doi-asserted-by":"publisher","first-page":"279","DOI":"10.3174\/ajnr.A4540","article-title":"Flow-diverter stents for the treatment of saccular middle cerebral artery bifurcation aneurysms","volume":"37","author":"Caroff","year":"2016","journal-title":"Am J Neuroradiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"687","DOI":"10.3174\/ajnr.A6002","article-title":"Treatment of unruptured distal anterior circulation aneurysms with flow-diverter stents: a meta-analysis","volume":"40","author":"Cagnazzo","year":"2019","journal-title":"Am J Neuroradiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2289","DOI":"10.3174\/ajnr.A5388","article-title":"Treatment of middle cerebral artery aneurysms with flow- diverter stents: a systematic review and meta-analysis","volume":"38","author":"Cagnazzo","year":"2017","journal-title":"Am J Neuroradiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.3171\/2018.7.JNS18654","article-title":"Flow diversion treatment of complex bifurcation aneurysms beyond the circle of Willis: Complications, aneurysm sac occlusion, reabsorption, recurrence, and jailed branch modification at follow-up","volume":"131","author":"Michelozzi","year":"2019","journal-title":"J Neurosurg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.3171\/2018.4.JNS172752","article-title":"Cerebral revascularization for the management of complex intracranial aneurysms: A single-center experience","volume":"131","author":"Nussbaum","year":"2019","journal-title":"J Neurosurg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"2043","DOI":"10.1016\/j.wneu.2015.07.050","article-title":"Venous-preserving sylvian dissection","volume":"84","author":"Maekawa","year":"2015","journal-title":"World Neurosurg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"800","DOI":"10.2176\/nmc.50.800","article-title":"What is the role of clipping surgery for ruptured cerebral aneurysms in the endovascular era? 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