Trapping and superficial temporal artery to middle cerebral artery bypass for treating middle cerebral myxomatous fusiform aneurysm: a case report and literature review

Cardiac myxomas are rare, predominantly benign tumors that most commonly occur in individuals aged 40–60 years, with a higher incidence in females. These tumors often exhibit friable surfaces, predisposing them to embolization. Systemic embolism occurs in up to 45 % of cases, frequently affecting cerebral circulation and leading to ischemic events. We report the case of a 41-year-old female with a history of left atrial myxoma who presented with recurrent transient paresthesia of the right upper limb. Imaging revealed multiple intracranial myxomatous aneurysms, including a large fusiform aneurysm in the M2 segment of the left middle cerebral artery. Surgical intervention involving aneurysm trapping and a superficial temporal artery–M2 (STA-M2) bypass was successfully performed. Neurological function remained symptom-free at 6-month follow up. Delayed-onset myxomatous fusiform aneurysms are rare and require tailored treatment. This case demonstrates the significance of STA-M2 bypass assisted trapping for complex intracranial aneurysms unsuitable for endovascular therapy, adding to the limited surgical literature.