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  • Title: Microsurgical Clipping of a Giant Middle Cerebral Artery Aneurysm with Successful Postoperative Endovascular Mechanical Thrombectomy for Emergent Treatment of Large Vessel Occlusion.
    Author: Prickett JT, Klein BJ, Cuoco JA, Patel BM, Fraser JC, Marvin EA.
    Journal: World Neurosurg; 2018 Feb; 110():359-364. PubMed ID: 29191534.
    Abstract:
    BACKGROUND: Giant intracranial aneurysms (>25 mm) are uncommon. These lesions typically manifest clinically due to mass effect, acute hemorrhage, or thromboembolic events. To minimize the risk of poor clinical outcome, detailed operative planning and a consideration of all neurosurgical and endovascular techniques are essential before proceeding with microsurgical clipping of ruptured giant aneurysms. CASE DESCRIPTION: We describe a case involving a 15-year-old male with a ruptured giant middle cerebral artery aneurysm treated with microsurgical clipping. After clip application, poor distal flow was demonstrated intraoperatively, and emergent angiography demonstrated an M1 occlusion with thrombus. A salvage procedure using endovascular mechanical thrombectomy reestablished distal flow resulting in a good neurologic outcome. CONCLUSIONS: To our knowledge, this is the first case report to describe microsurgical clipping of an aneurysm followed by successful postoperative endovascular mechanical thrombectomy.
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