• Hiroshi Yokota, Kazuhiro Yokoyama, and Hiroshi Noguchi.
• Department of Neurosurgery, Higashiosaka City General Hospital, Osaka, Japan. Electronic address: hyokota0001@gmail.com.
• World Neurosurg. 2016 Aug 1; 92: 583.e7-583.e12.

BackgroundDe novo aneurysm formation has been reported as a rare complication of superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery.Case DescriptionThe first patient with intracerebral hemorrhage had a ruptured de novo aneurysm arising from the recipient MCA at 6 years after undergoing STA-MCA bypass for hemispheric hemodynamic insufficiency. In the second case, an enlarging unruptured STA aneurysm was detected by follow-up magnetic resonance angiography at 8 years after the patient underwent STA-MCA bypass for moyamoya disease. Both patients were successfully treated by surgical clipping.ConclusionsPersistent hemodynamic stress with hypertension in an artificial T-shaped vasculature and traumatic injury during surgical manipulation are the most important causes for de novo aneurysms after STA-MCA bypass. Follow-up magnetic resonance and computed tomography angiography examinations, along with appropriate blood pressure control, are recommended for patients who have undergone STA-MCA bypass surgery.Copyright © 2016 Elsevier Inc. All rights reserved.

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