title: Extracranial-intracranial vein graft bypass for giant intracranial aneurysm surgery for pediatric patients: two technical case reports.
abstract: OBJECTIVE
  Herein we describe two cases of extracranial-intracranial vein graft bypasses for the treatment of giant intracranial aneurysms in prepubertal pediatric patients. One patient is, we think, the youngest patient reported in the literature to have been successfully treated in such a manner, with a good long-term outcome. Such grafts seem to enlarge longitudinally during the growth spurt, making such techniques reasonable long-term therapeutic options for the management of complex intracranial aneurysms in pediatric patients.
  
  
  METHODS
  Patient 1, a 13-year-old boy, presented with headaches and rapidly progressive right cavernous sinus syndrome. Computed tomography and cerebral angiography revealed a giant, fusiform, right intracavernous internal carotid artery aneurysm. Patient 2, a 23-month-old girl, was discovered to harbor an asymptomatic, recurrent, giant, fusiform, left M1 middle cerebral artery aneurysm 1 year after presenting with seizures related to subarachnoid hemorrhage from the aneurysm, for which she had been treated with clipping and an M2-M2 anastomosis.
  
  
  METHODS
  Both patients underwent craniotomies, with sacrifice of the proximal parent vessel (the distal cervical internal carotid artery and the proximal middle cerebral artery, respectively), combined with cerebral revascularization through extracranial-intracranial saphenous vein bypass grafts. Both patients experienced excellent long-term clinical outcomes, have undergone significant growth, and exhibit excellent long-term graft patency and aneurysm obliteration.
  
  
  CONCLUSIONS
  These two cases highlight the safety and efficacy of extracranial-intracranial vein graft bypasses among prepubertal pediatric patients. The indications for bypass procedures to treat giant intracranial aneurysms are discussed, and the technical aspects of maximizing vein bypass graft patency are reviewed.
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
authors.forename: Y Jonathan
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Barrow
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Day
mesh_terms: D000293:Adolescent; D001807:Blood Vessel Prosthesis; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D005260:Female; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D016896:Treatment Outcome; D014654:Vascular Patency