• Yue Ma, Jianwen Liao, Zhouyang Zhao, Weijia Huang, Chen Yang, Yimei Yang, Meiyun Zheng, and Lijin Huang.
• Department of Neurosurgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
• World Neurosurg. 2023 Aug 1; 176: e14e19e14-e19.

ObjectiveBoth craniotomy and interventional embolization are difficult and risky to treat complex middle cerebral artery (MCA) aneurysms in infants. Trapping with revascularization is a therapeutic option for giant aneurysms that cannot be clipped or coiled alone.MethodWe describe a technical method using revascularization with a natural Y-shaped palmar common digital artery interposition graft that provides a normal variation for a complex MCA aneurysm in an infant with intracerebral hemorrhage at 37 days of age. Conservative treatment was performed at that time. Seven months later, the patient was re-admitted to the hospital and was confirmed a large aneurysm in the M2 segment of the right MCA by cerebral angiography. A natural artery palmar common digital artery Y-graft was used as the graft and anastomosed to the M2 and both M3 trunks.ResultThe symptoms improved after surgery, and the mRS score of the patient was 1 after 5 years of follow-up.ConclusionThe palmar common digital artery can be an option for intracranial revascularization bypass in complex intracranial aneurysms.Copyright © 2023 Elsevier Inc. All rights reserved.

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