ReviewExtracranial to intracranial bypass for the treatment of cerebral aneurysms in the pediatric population

- Aneurysms in the pediatric population are more frequently fusiform and giant when compared to the adult population.
- Revascularization options should be considered in these cases in order to achieve aneurysm obliteration.
- Despite the complexity of pediatric aneurysms, bypass surgery can offer a safe and effective treatment in select cases.

Cerebral aneurysms are rare in the pediatric population, making a definitive treatment algorithm difficult. Microsurgical clipping is the first choice for treatment but is not always feasible, while high recurrence rates and radiation exposure make endovascular options less favorable. Extracranial-intracranial (EC-IC) bypass, though not commonly performed in the pediatric aneurysm population, has been reported in a small number of studies to be both safe and effective for the management of cerebral aneurysms. The authors present the case of a child with a distal middle cerebral artery (MCA) aneurysm in eloquent territory, successfully treated with a superficial temporal artery (STA) to MCA bypass and trapping. A review of the current literature on pediatric EC-IC bypass in the treatment of intracranial aneurysms is presented.