Giant serpentine aneurysm of the middle cerebral artery

Abstract

Giant serpentine aneurysms are rare and have distinct angiographic findings. The rarity, large size, complex anatomy and hemodynamic characteristics of giant serpentine aneurysms make treatment difficult. We report a case of a giant serpentine aneurysm of the right middle cerebral artery (MCA) that presented as headache. Treatment involved a superficial temporal artery (STA)-MCA bypass followed by aneurysm resection. The patient was discharged without neurological deficits, and early and late follow-up angiography disclosed successful removal of the aneurysm and a patent bypass graft. We conclude that STA-MCA bypass and aneurysm excision is a successful treatment method for a giant serpentine aneurysm.

Keywords: Angiographic feature; Bypass surgery; Giant serpentine aneurysm.

Fig. 1

Preoperative images of the giant serpentine aneurysm. A : A preoperative axial CT image showing a round, iso-dense mass with peripheral calcification, midline shifting and peripheral edema. B : A preoperative coronal MR image demonstrating the mass effect with midline shifting, and a thrombus within the aneurysm.

Fig. 2

Preoperative angiographic features of the giant serpentine aneurysm. A : Left anterolateral projection CT angiography image showing tortuous and thick "serpiginous" blood vessels. B : A preoperative angiographic lateral view showing superior displacement of the right middle cerebral artery and distal blood supply from the serpiginous artery.

Fig. 3

Postoperative images showing with proximal and distal clipping of the giant serpentine aneurysm and bypass surgery. A : A postoperative axial CT image showing improved midline shifting, lack of mass effect and peripheral edema. B : A lateral view of common carotid arteriorgraphy showing lack of the aneurysm and dye filling to the distal MCA territory through the bypass.