title: Treatment of giant and large fusiform middle cerebral artery aneurysms with excision and interposition radial artery graft in a 4-year-old child: case report.
abstract: BACKGROUND
  We report an unusual case of complex giant and large fusiform aneurysms not amenable for clipping or coiling in a 4-year-old child managed with aneurysm resection and radial artery interposition graft.
  
  
  METHODS
  A 4-year-old child presented with repeated severe headache and vomiting. Computed tomography, magnetic resonance imaging, and magnetic resonance angiography and digital subtraction angiography showed a giant fusiform aneurysm on the right middle cerebral artery (MCA). Because of the complex shape, endovascular treatment or clip reconstruction was not possible, and a bypass procedure was planned. Right frontotemporal craniotomy and orbitotomy was performed. Two aneurysms involving the M1 segment of the MCA were found in line, 1 giant, and the other large in size. The aneurysms were resected and treated with short radial artery interposition graft, which was narrower than the proximal or distal MCA. The child recovered normally, and the bypass was patent after 1 year.
  
  
  CONCLUSIONS
  Large fusiform MCA aneurysms may be difficult to treat, but there are treatment options that include a bypass procedure. Resection and short interposition radial artery graft is an excellent but rare treatment option in a very young child. This was a very successful treatment in this child.
authors: *Department of Neurosurgery, Clinical Hospital Centre Zagreb- Rebro, School of Medicine Zagreb, Zagreb, Croatia; ‡Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, Washington.
authors: Goran
authors: G
authors: Mrak
authors: Josip
authors: J
authors: Paladino
authors: Vasilije
authors: V
authors: Stambolija
authors: Jakob
authors: J
authors: Nemir
authors: Laligam N
authors: LN
authors: Sekhar
mesh_terms: D000758:Anesthesia; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D002675:Child, Preschool; D003399:Craniotomy; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017534:Radial Artery / Q000637:transplantation*; D014057:Tomography, X-Ray Computed