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.