Article Text

Download PDFPDF
Combined microsurgical and endovascular treatment of a giant left middle cerebral artery aneurysm
  1. Ali Zomorodi1,
  2. Ketan R Bulsara2,
  3. Allan H Friedman1,
  4. Michael J Alexander3
  1. 1Duke University Medical Center, Durham, North Carolina, USA
  2. 2Yale Department of Neurosurgery, New Haven, Connecticut, USA
  3. 3Maxine Dunitz Department of Neurosurgery, California, USA
  1. Correspondence to Michael Alexander MD Professor and Vice-Chairman Department of Neurosurgery Cedars-Sinai Medical Center Director, Cedars-Sinai Neurovascular Center 86311 West Third Street, Suite 800E Los Angeles, California 90048; michael.alexander{at}


Giant fusiform aneurysms of the middle cerebral artery (MCA) bifurcation pose significant treatment challenges. A giant fusiform aneurysm of the left MCA in a pediatric patient, which persisted despite Hunterian ligation of the M1 and double barrel superficial temporal artery (STA) to M2 bypasses, is reported. The aneurysm was trapped by endovascular coiling of the feeding M2 trunk through the STA anastamosis. Hunterian ligation combined with extracranial–intracranial bypass is an effective technique for treating giant fusiform aneurysms of the MCA bifurcation for patients who fail balloon test occlusions. However, in certain cases, flow reversal may not eliminate the aneurysm and continued aneurysm filling may occur through retrograde filling from the bypass recipient vessels. In these cases, endovascular trapping of the aneurysm may be undertaken through the bypass graft. The feasibility of this management scheme is demonstrated.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.