• Masato Shiba, Naoki Toma, Munenari Ikezawa, Yusuke Kuroda, Yume Suzuki, Reona Asada, Yoichi Miura, Ryuta Yasuda, and Hidenori Suzuki.
• Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan. Electronic address: mshiba@med.mie-u.ac.jp.
• World Neurosurg. 2020 Oct 1; 142: 328-333.

BackgroundVascular reconstruction is required to treat infectious intracranial aneurysms (IIAs) on arteries supplying the eloquent area. However, extracranial-intracranial bypass is sometimes impossible because IIAs are frequently located distally on arteries and the length of a donor artery is limited. We report a rare case of an unruptured Gemella morbillorum IIA, which was successfully treated by intracranial-intracranial (IC-IC) bypass using a Y-shaped superficial temporal artery (STA) interposition graft.Case DescriptionA 52-year-old man presented with heart failure and an unruptured IIA in the right anterior parietal artery because of acute G. morbillorum endocarditis. The patient was treated with urgent replacement of cardiac valves and antibiotic therapy. However, the IIA increased in size during the following 1 month, and therefore was treated surgically to prevent the rupture. End-to-side IC-IC bypass using a Y-shaped STA graft followed by aneurysmal trapping was performed to overcome the limited length of the STA as a donor artery to prevent cerebral ischemia in the artery territory and to avoid direct injury to the sensory cortex adhering tightly to the IIA. Postoperative courses were uneventful, and he recovered from the infectious diseases.ConclusionsThis case suggests that end-to-side IC-IC bypass using a Y-shaped STA graft can be a good option for surgical treatment of IIAs, which are located in eloquent areas.Copyright © 2020 Elsevier Inc. All rights reserved.

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