This video is a nice example, of clip ligation of two consecutive aneurysms within the MCA vascular tree. This is a 45 year old male who presented with a one centimeter ruptured left sided MCA bifurcation aneurysm, and was also found to have a four millimeter unruptured, anterior temporal artery aneurysm. CT angiogram demonstrates the dysmorphic feature of the MCA bifurcation aneurysm, as well as a very small anterior temporal artery aneurysm, slightly more proximately along the MCA vascular tree. The pattern of hemorrhage on the CT scan is apparent and most likely the larger, more dysmorphic MCA bifurcation aneurysms is responsible for the subarachnoid hemorrhage. A left sided, front temporal craniotomy was used to approach both aneurysms. Sylvian fissure was significantly at here in this case. The M1 was explored and exposed, initially, you can see the larger atherosclerotic aneurysm, with adherent M2 trunks. First, the more proximal aneurysm was managed and clip ligated, you can see the very broad base, anterior temporal artery aneurysm, which is very typical off these aneurysms. A small or short curved clip was used. This clip did not close the entire neck of the aneurysm. It was subsequently repositioned so, that the proximal neck is also excluded. This time the tips of the clips spend the entire length of the neck. Next, a set of clips were used to exclude the atherosclerotic MCA bifurcation aneurysm without compromising the adherent M2 trunks. Perforating vessels were carefully protected. The neck appears completely collapsed, and deflation of the aneurysm revealed exclusion of the lesion from the circulation. Post operative angiogram demonstrated desirable results, and exclusion of both aneurysms. Thank you.
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