Complex middle cerebral artery aneurysms: a new classification based on the angioarchitecture and surgical strategies
A 28-year-old woman presented with a headache. A CT scan revealed a giant lesion in the left front-temporal lobe. A DSA confirmed it was a giant serpentine aneurysm originating from the M2 segment. Open surgery was required. The aneurysm was exposed using the left pterional approach, and a STA-RA-M3 bypass was performed. After confirming the graft patency, the proximal and distal M2 segments were temporary occluded. Intraoperative MEP and SEP showed no change after 30 min of occlusion. Therefore, the aneurysm was trapped and eventually resected. The patient recovered well without any neurological deficits. The postoperative CTA showed that the aneurysm had been completely obliterated, and the graft was patent.