title: The combined treatment of stenting and surgery in a giant unruptured aneurysm of the middle cerebral artery.
abstract: BACKGROUND
  This case study reports on a combined therapy of stenting and surgery for a giant unruptured middle cerebral artery (MCA) aneurysm with the aim of preserving the patency of the vessel during surgery.
  
  
  METHODS
  A 51-year-old male presented with a sudden onset of moderate left hemiparesis and dysarthria. Neuro-radiological evaluations showed a giant right unruptured MCA aneurysm without subarachnoid hemorrhage (SAH). The cerebral angiography confirmed the presence of such an aneurysm producing compression of both M2 branches with consequent slowing of the blood flow. Two weeks later, the patient underwent the positioning of an Enterprise stent and inside this, a flow diverter Silk stent. They were placed across the aneurysm and in one of the two M2 branches with the aim of protecting them during surgical manipulation. The patient went immediately to surgery, where the aneurysm was resected and both M2 branches decompressed.
  
  
  CONCLUSIONS
  The combined placement of the stents allowed safe and successful surgical dissection of the M2 branches and clipping of the aneurysm without interrupting the blood flow.
authors.affiliation: Department of Neurosurgery, Udine University-Hospital P. le S. Maria della Misericordia 15, 33100, Udine, Italy.
authors.forename: Miran
authors.initials: M
authors.lastname: Skrap
authors.affiliation: Department of Neuroradiology, Udine University-Hospital P. le S. Maria della Misericordia 15, 33100, Udine, Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Petralia
authors.affiliation: Department of Neurosurgery, Udine University-Hospital P. le S. Maria della Misericordia 15, 33100, Udine, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Toniato
keywords: Aneurysm; clip; combined treatment; stent