CASE REPORT article
Front. Surg.
Sec. Neurosurgery
Case report: De novo multiple intracranial aneurysms following extracranial– intracranial bypass and proximal occlusion for a giant serpentine aneurysm
Provisionally accepted
- 1Nanjing University of Chinese Medicine School of Medicine, Nanjing, China
- 2University of Brescia, Brescia, Italy
- 3Huashan Hospital Fudan University, Shanghai, China
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Background: Carotid artery occlusion, whether therapeutic, iatrogenic, atherosclerotic, or congenital, induces profound hemodynamic changes in the cerebral circulation. Collateral channels within the circle of Willis compensate to maintain cerebral perfusion; however, the resulting increases in flow velocity, wall shear stress, and pressure gradients are believed to ultimately contribute to aneurysm formation. While de novo aneurysms after hunterian ligation have been described, they typically occur years after treatment. The early occurrence of multiple aneurysms following parent artery occlusion combined with extracranial-intracranial (EC-IC) bypass has seldom been reported. Here, we report a unique case of multiple, non-anastomotic MCA aneurysms developing early after double-barrel bypass and proximal clipping. Case Description: A 27-year-old male with severe headache was found to have a partially thrombosed giant serpentine aneurysm (GSA) of the left M2 inferior trunk. The patient underwent double-barrel superficial temporal artery–middle cerebral artery (STA–MCA) bypass followed by proximal clipping. Postoperative imaging confirmed complete exclusion of the aneurysm and excellent bypass patency. Three months later, acute aphasia and right hemiparesis developed. Angiography revealed two newly formed aneurysms along the left MCA bifurcation point and the M2 superior trunk, which were successfully treated with endovascular coil embolization and parent artery occlusion. At nine-month follow-up, the patient remained neurologically intact with patent bypass grafts and no aneurysm recurrence. Conclusions: This case illustrates an unusual pattern of early, multiple, non-
Keywords: de novo aneurysm, Giant serpentine aneurysm, Extracranial-intracranial bypass, case report, STA-MCA bypass
Received: 25 Oct 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Xu, Latour, Xu, Fontanella and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Kristy Latour
Feng Xu
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