Internal maxillary artery to middle cerebral artery bypass for a complex recurrent middle cerebral artery aneurysm: case report and technical considerations.

We report the case of a 41-year-old male who presented with an enlarging aneurysm neck one year after clipping. The patient underwent an IMAX-MCA bypass followed by endovascular coil occlusion of the aneurysm neck incorporating an MCA branch origin. To our knowledge, this case represents the first documented IMAX-MCA bypass from a European centre. This case demonstrates that for neurosurgeons experienced in EC-IC bypass surgery, IMAX-MCA bypass is feasible and can be performed safely as long as careful attention is paid to anatomical landmarks and vascular anastomosis principles. CTA-based neuronavigation and micro-Doppler are essential intraoperative tools for identifying the IMAX.