title: Intraoperative color-coded duplex sonography for localization of a distal middle cerebral artery aneurysm: technical case report.
abstract: OBJECTIVE
  We describe the surgical treatment of a small, distal, middle cerebral artery (MCA) aneurysm, performed using intraoperative color-coded duplex sonography for localization.
  
  
  METHODS
  A 55-year-old man presented with a sudden intense headache. Computed tomographic scans revealed a subarachnoid hemorrhage. Angiography demonstrated two MCA aneurysms, one arising from the proximal bifurcation of the right MCA and the other from its distal bifurcation.
  
  
  METHODS
  On Day 1, the proximal MCA aneurysm was clipped via the standard transsylvian approach. The distal MCA aneurysm was identified with the aid of color-coded duplex sonography and was successfully clipped with minimal additional dissection of the sylvian fissure.
  
  
  CONCLUSIONS
  Color-coded duplex sonography provides a two-dimensional image of the brain parenchyma and color-coded flow imaging of cerebral vessels in real time. It may be used for rapid intraoperative localization of small, distally located, cerebral aneurysms.
authors.affiliation: Department of Neurosurgery, University Hospital of Zürich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Payer
authors.forename: Y
authors.initials: Y
authors.lastname: Kaku
authors.forename: R
authors.initials: R
authors.lastname: Bernays
authors.forename: Y
authors.initials: Y
authors.lastname: Yonekawa
mesh_terms: D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex