This short video describes Clip Ligation of large potentially atherosclerotic MCA aneurysms. This is a 68 year old female with a 14 millimeter on ruptured right-sided aneurysm. The morphology of the aneurysm in each projection more inferiorally is demonstrated. The exposure of this aneurysm is relatively straightforward via the right side of trans sylvian approach. You can see the neck of the aneurysm, the atherosclerosis present there. A temporary clip was placed across the M1. So the neck can be further manipulated. A long curved clip was placed across the neck. Avoiding the atherosclerotic part. You can see the neck is completely excluded intraoperative fluorescein angiography, as well as ICG reveal complete exclusion of the aneurysm due to the broad neck of the aneurysm and the presence of atherosclerosis, additional curved clip as well as a straight fenestrated clip were placed to minimize the risk of delayed clip displacement, post operative angiogram confirms complete exclusion of aneurysm, thank you.
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