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P490: DUAL REVASCULARIZATION OF BOTH M2 DIVISIONS WITH IMAX-RADIAL ARTERY AND STA BYPASS FOR GIANT FUSIFORM ANEURYSM
Daniele Starnoni; Danielle Golub; Amir R Dehdashti; Northwell Health

This video presents the microsurgical treatment of a giant fusiform aneurysm of the middle cerebral artery in a 74-year-old patient. The surgical strategy included aneurysm trapping with double bypass: a high-flow bypass using the internal maxillary artery and radial artery graft, and a low-flow bypass using the superficial temporal artery. A fronto-orbito-zygomatic approach was performed. Intraoperative ICG and Doppler confirmed complete aneurysm exclusion and robust distal perfusion. Postoperative imaging showed near-complete thrombosis without neurological deficits.

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