Multiple clips reconstruction for giant fusiform Middle Cerebral Artery aneurysm

Background: Surgical treatment of giant fusiform Middle Cerebral Artery (MCA) aneurysms represents a surgical challenge owing to complex vascular anatomy, and the need to preserve precious arteries to avoid long-lasting morbidities. Cerebral revascularization imposes itself as the most efficient option whenever possible. We present a case of a giant fusiform MCA aneurysm for whom we performed thrombectomy & multiple clips reconstruction. We highlighted the different treatment options mentioned in the literature. Case report: A 38-year-old male patient presented with a disturbed conscious level and obvious heaviness on his left side. Brain imaging revealed a ruptured partially thrombosed MCA aneurysm arising from the superior di-vision of M2, we evacuated the thrombus and performed aneurysmorraphy via multiple clip reconstruction, the patient had a good recovery, and follow-up angiography after six months revealed no regrowth of the aneurysm. Conclusion: The treatment of giant fusiform MCA aneurysm is a surgical challenge. Multiple clips reconstruction is a potential salvage surgical option, whenever cerebral revascularization couldn't be done. Cerebral bypass is the best option to avoid ischemic insults and to guarantee adequate flow to the perforators, it should be the first option whenever possible.