title: A case of ruptured infectious anterior cerebral artery aneurysm treated by interposition graft bypass using the superficial temporal artery.
abstract: BACKGROUND
  To describe the application of an interposition graft bypass using superficial temporal artery (STA) for the treatment of a ruptured anterior cerebral artery (ACA) infectious aneurysm.
  
  
  METHODS
  A 30-year-old male suffered from severe headache with high fever. The patient's diagnosis was ruptured infectious ACA aneurysm at the A3 segment with a maximum diameter of 4.5 mm, caused by infectious endocarditis. The patient was initially treated with high-dose intravenous antibiotics. Follow-up digital subtraction angiography (DSA) revealed that the fusiform aneurysm had enlarged to a maximum diameter of 14.0 mm. A left paracentral artery, supplying the motor area of the left lower extremity, originated from the body of this aneurysm. Because the angiographic findings suggested a risk of recurrent bleeding, the patient underwent open surgery. Interposition graft bypass using the STA was performed to reconstruct the left A3 segment in an end-to-side manner (left proximal callosomarginal artery - STA graft - left distal pericallosal artery). Then, the origin of the left paracentral artery was cut and anastomosed to the STA graft in an end-to-side manner. The affected parent artery was trapped, and the aneurysm was resected. Postoperative magnetic resonance imaging showed no ischemic or hemorrhagic complications, and postoperative DSA revealed the patency of the interposition graft. Pathological diagnosis of the resected aneurysm revealed features corresponding to infectious cerebral aneurysm. The postoperative course was uneventful, and the patient was discharged without any neurological deficits.
  
  
  CONCLUSIONS
  In the treatment of infectious cerebral aneurysms, revascularization should be considered when the affected artery supplies the eloquent area. Interposition graft bypass using the STA is one of the options for revascularization surgery for the treatment of infectious ACA aneurysms.
authors: Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
authors: Takatsugu
authors: T
authors: Abe
authors: Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
authors: Hidenori
authors: H
authors: Endo
authors: Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan.
authors: Hiroaki
authors: H
authors: Shimizu
authors: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Miki
authors: M
authors: Fujimura
authors: Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
authors: Toshiki
authors: T
authors: Endo
authors: Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
authors: Hiroyuki
authors: H
authors: Sakata
authors: Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Mika
authors: M
authors: Watanabe
authors: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Teiji
authors: T
authors: Tominaga
keywords: Anterior cerebral artery; infectious cerebral aneurysm; interposition graft bypass; subarachnoid hemorrhage; superficial temporal artery