Techniques and application in anterior cerebral artery–radial artery–middle cerebral artery bypass for complex middle cerebral artery aneurysms: donor selection, anastomosis technique, and clinical outcomes

ACA-RA-MCA bypass is a safe and durable revascularization option for selected complex MCA aneurysms, especially those unsuitable for direct clipping or flow diversion. The use of the ACA as a donor provides favorable hemodynamic and intraoperative flexibility, particularly when performed in a hybrid operating room. Despite risks of perforator-related ischemia, mastering and understanding this surgical technique still remains critically important and necessary in the treatment of complex MCA aneurysms.