A 36-year-old man in normal health presented with giant aneurysm of the right VA manifesting as subarachnoid hemorrhage. The left VA was occluded, and a balloon occlusion test (BOT) of the right VA was positive. The patient was treated with aneurysmal trapping and high flow bypass (EC-RA-V4 bypass). The patient suffered from acute epidural hematoma on eight days after the surgery. Intraoperative observation revealed that the arterial bleeding was from the RA, so hemostatic suture was performed. After the surgery, the RA-VA bypass was occluded. He died of brain stem infarction 22 days after surgery.
Although the outcome of this case was poor, we think that EC-RA-V4 bypass remains an important option in similar cases.
