Complex middle cerebral artery aneurysms: a new classification based on the angioarchitecture and surgical strategies
A 45-year-old man presented with a headache. The CT and MRI scans showed a large lesion in the right sylvian fissure, and a partially thrombosed giant aneurysm was suspected. The DSA confirmed the diagnosis as a giant right MCA aneurysm originating from the M3 segment. During the surgery, it was found to be an unclippable aneurysm because of its dissecting morphology. Therefore, the proximal parent artery was temporary clipped under MEP monitoring. No MEP change was detected during the 30-min monitoring period. Therefore, the aneurysm was treated with a simple clipping on the proximal segment of M3. The patient recovered from the surgery without any neurological deficits. The postoperative CTA and DSA showed complete obliteration of the aneurysm.