Abstract
Clipping surgeries for unusual middle cerebral artery (MCA) aneurysm are not always easy because of ischemic complications of the lenticulostriate arteries (LSAs) and MCA branches. Superior-wall type of M1 aneurysms have highest risks of perforator infarction caused by LSA occlusion or kinking by applied clips. At clipping surgeries for deeply located MCA aneurysms of the early MCA bifurcation and M1 aneurysms (superior-wall type, inferior-wall type, and early branch portion), excessive brain retraction and frequent use of temporary clips should be avoided as much as possible and a wide working field should be obtained against ischemic complications. Surgeons should be aware that LSAs are branching not only at the MCA trunk but also at the MCA bifurcation and M2 when applying clips to MCA aneurysms.
Vascular reconstruction of bypass surgery is a good surgical option for complicated MCA aneurysms not amenable to microsurgical clipping.
