Here's another case of a ruptured small MCA aneurysm, a rather straightforward one. Patient presented with spontaneous subarachnoid hemorrhage. Actually, was found to have two MCA aneurysms, and the smaller one was the cause of the right-sided sylvian subarachnoid hemorrhage in this case. Right-sided craniotomy was completed. Sylvian fissure was dissected. Here you can see the base of the aneurysm, the M2 branch. First, the M1 was exposed for temporary control. Here's the aneurysm. Temporary clip was used on distal M1 so that the neck of the aneurysm can be circumferentially isolated. Here you can see the MCA bifurcation. The inferior wall of the aneurysm was dissected, curved clip was used. The blades are across the entire neck of the aneurysm. Fluorescence revealed complete exclusion of the aneurysm in this case, and postoperative CT scan revealed no evidence of ischemia, and angiogram demonstrated complete exclusion of the aneurysm. The patient subsequently underwent clip ligation of a contralateral MCA bifurcation aneurysm approximately three months after this initial surgery. Thank you.
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