{"id":"ace0d532-3f4e-4992-90ba-bca458feb328","slug":"high-flow-bypass-surgery-for-a-large-cavernous-internal-carotid-artery-aneurysm-associated-with-persistent-primitive-trigeminal-artery-a-case-report","title":"High-flow bypass surgery for a large cavernous internal carotid artery aneurysm associated with persistent primitive trigeminal artery: A case report","authors":["Yu Otaki","Tatsuya Shimizu"],"abstract":"Background: Giant cavernous internal carotid artery (ICA) aneurysms present with therapeutic challenges, especially if associated with a persistent primitive trigeminal artery (PPTA). Although flow diverters (FDs) are commonly used, the PPTA can maintain collateral inflow to the aneurysm sac, preventing complete thrombosis. Case Description: A 74-year-old woman presented with progressive oculomotor nerve palsy and visual decline. High-flow external carotid-middle cerebral artery bypass with distal ICA occlusion beyond the aneurysm was performed. The bypass remained patent without infarction, and partial aneurysm thrombosis occurred, whereas PPTA flow was preserved. Conclusion: This case emphasizes the importance of individual microsurgical strategies if FD treatment may be ineffective due to complex embryonic vascular anatomy.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/ace0d532-3f4e-4992-90ba-bca458feb328/featured/hero-1781557936182.png","publishDate":"2026-02-06T00:00:00.000Z","doi":"10.25259/SNI_1366_2025","categories":["Neurovascular","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2026/02/14283/SNI-17-73.pdf"}