大脑中动脉 M1 段复杂的梭形动脉瘤较为罕见且手术难度大，其特征为环形扩张，常累及穿支动脉，并伴有动脉粥样硬化改变。当直接夹闭或血管内治疗不可行时，颅内-颅内（IC - IC）搭桥术是一种合理的血管重建选择。

文章中说，一名 55 岁男性患者因左侧大脑中动脉 M1 段出现一个未破裂的梭形动脉瘤前来就诊。术前CTA/DSA和高分辨率血管壁磁共振成像显示动脉瘤壁局部强化，但无明显内膜瓣。术中鉴于动脉瘤的局部形态以及穿支血管受累情况，实施了 IC-IC A1-M2 桡动脉搭桥，并对近端 M1 进行了闭塞。 术中血管造影显示移植血管通畅，豆纹动脉逆向灌注良好。 术后DSA证实M2双干血流得以保留，动脉瘤内血流灌注明显降低。患者神经功能完好出院， 3 个月随访时未出现神经功能缺损。

研究结论认为，对于部分复杂的M1段梭形动脉瘤，从 A1 到 M2 的高流量颅内-颅内搭桥术并近端闭塞是 一种安全有效的策略，可在常规治疗手段有限的情况下，保留远端及穿支血流，同时减少动脉瘤的血流流入。

Figure 1. Preoperative neuroimaging assessment. (A) Anteroposterior digital subtraction angiography (DSA) showing a fusiform aneurysm of the left MCA M1 segment. (B) Lateral DSA view demonstrating the aneurysm's extension from proximal M1 to the bifurcation. (C) 3D rotational angiography, lateral projection, illustrating the origin of both M2 divisions from the aneurysmal segment. (D) 3D rotational angiography, anteroposterior projection, revealing vessel morphology. (E) High-resolution vessel-wall magnetic resonance imaging (MRI) showing focal wall enhancement of the aneurysm, indicating an increased risk of rupture. MCA, middle cerebral artery.

Figure 2. Steps of interposition IC–IC bypass and proximal aneurysm trapping. (A) Pterional skin incision with planned zygomatic extension. (B) Dural opening reflected anteriorly toward the sphenoid ridge. (C) Wide transsylvian dissection exposing a calcified M1 fusiform aneurysm. (D) Identification of the lateral lenticulostriate arteries arising distal to the aneurysm. (E) End-to-side anastomosis of the radial artery (RA) graft to the ipsilateral A1 segment. (F) End-to-side anastomosis of the RA graft to the inferior division of M2. (G) Completed A1–RA–M2 interposition bypass prior to trapping. (H) Proximal occlusion of the M1 segment with aneurysm remodeling. (I) Intraoperative indocyanine green (ICG) angiography confirming patency of the bypass, lenticulostriate arteries, and both M2 divisions. IC-IC, intracranial-intracranial.

Figure 3. Intraoperative angiography after aneurysm trapping and interposition IC–IC bypass. (A) Anteroposterior DSA showing reduced flow within the aneurysm and graft patency. (B) Oblique view demonstrating intact lenticulostriate perfusion. (C) 3D rotational angiography highlighting the interposition RA graft (colored in purple). (D) Intraoperative surgical view showing the course of the graft and both anastomosis sites. IC-IC, intracranial-intracranial; RA, radial artery; DSA, digital subtraction angiography.

Figure 4. Illustration of the key surgical steps. (A). Exposure of the fusiform M1 aneurysm through a zygomatic–pterional approach. (B). View after completion of the A1–M2 radial artery bypass and proximal aneurysm occlusion. (C). Schematic illustration of the surgical strategy with purple arrows indicating blood flow direction.

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