Cerebral Myxomatous Aneurysm Treated by M2-M2 Bypass: A Case Report

Corresponding author: Jae Sung Ahn Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea Tel: +82-2-3010-3550 Fax: +82-2-476-6738 E-mail: jsahn@amc.seoul.kr Intracranial aneurysms associated with atrial myxoma have been reported and termed “myxomatous aneurysms.” We present a case of cerebral myxomatous aneurysms treated by M2-M2 bypass surgery. A 20-year-old woman was admitted for evaluation and management of multiple cerebral aneurysms found incidentally. She had a history of right middle cerebral artery (MCA) territory infarction with MCA total occlusion. At that time, cardiac myxoma was incidentally found and surgically removed. In cerebral angiography, multiple cerebral aneurysms were identified. Among them, a right MCA fusiform aneurysm was the largest, with a diameter of 19.5 mm; notably, this developed at the site of previous MCA occlusion. Through surgical exploration, an MCA bifurcation aneurysm was observed, with a permanently occluded inferior trunk toward the temporal lobe. M2-M2 end-to-end anastomosis with resection of aneurysm was successfully performed, and biopsy showed dilation and thickening of the aneurysmal wall without any evidence of tumor invasion. The outcome of this case shows that surgical resection with bypass surgery is a useful option for the treatment of cerebral myxomatous aneurysms.