Utility of fenestrated straight clips in microsurgical clip reconstruction of an atherosclerotic middle cerebral artery aneurysm extensively involving two efferent arteries: Technical case report

Clip reconstruction of morphologically complex aneurysms is challenging. A clipping technique for an atherosclerotic middle cerebral artery (MCA) aneurysm extensively involving two M2 branches is presented. A 68-year-old woman was referred to our hospital for treatment of an unruptured left MCA aneurysm. Three-dimensional computed tomography angiography showed a middle cerebral artery aneurysm extensively involving two M2 branches. The aneurysm was treated by surgical clipping via a left pterional approach. Due to concern about significant remnant neck and clip slippage due to the wide-neck and atherosclerotic features, two straight fenestrated clips were applied across one M2 branch and in parallel to another M2 branch. The aneurysm was successfully obliterated without a significant remnant neck and narrowing of the efferent arteries. The patient recovered from surgery uneventfully. Parallel clip reconstruction with fenestrated clips may be a useful alternative to reduce the postclipping remnant of wide-neck and atherosclerotic aneurysms.