title: Middle cerebral artery fusiform aneurysm presented with stroke and delayed subarachnoid hemorrhage trapping, thrombectomy, and bypass.
abstract: BACKGROUND
  Ischemic stroke is a well-described but less frequent consequence of ruptured or unruptured intracranial aneurysms. To date, the optimal form of treatment for patients with a thrombosed cerebral aneurysm has not yet been well-defined.
  
  
  METHODS
  Here, we report a case of a 68-year-old female patient presenting with cerebral stroke. Five days poststroke multislice computed tomography (MSCT) and MSCT angiography were performed for the evaluation of clinical deterioration, showing a left M2 middle cerebral artery (MCA) bifurcation aneurysm and subarachnoid hemorrhage. Having in mind the high mortality and morbidity rates after a re-rupture, as well as the digital subtraction angiography features of the aneurysm, urgent surgery was performed consisting of aneurysm trapping and superficial temporal artery (STA) to M3 MCA segment end-to-side anastomosis. The surgery and early postoperative period proceeded uneventfully and the patient gradually recovered from the previously diagnosed expressive dysphasia and cranial and extremity motor deficit.
  
  
  CONCLUSIONS
  Our case describes a complex aneurysm treatment that consisted of aneurysm trapping, thrombus removal and an STA-M3 MCA branch bypass creation for the protection of the patent M3 insular MCA branch and prevention of further ischemia. This procedure rewarded us with an excellent clinical result.
authors.affiliation: Department of Neurosurgery, University Hospital Centre Zagreb, Zagreb 10 000, Croatia; School of Medicine, University of Zagreb, Zagreb 10 000, Croatia.
authors.forename: Goran
authors.initials: G
authors.lastname: Mrak
authors.affiliation: Department of Neurosurgery, University Hospital Centre Zagreb, Zagreb 10 000, Croatia.
authors.forename: Kresimir Sasa
authors.initials: KS
authors.lastname: Duric
authors.affiliation: Department of Neurosurgery, University Hospital Centre Zagreb, Zagreb 10 000, Croatia.
authors.forename: Jakob
authors.initials: J
authors.lastname: Nemir
keywords: Cerebral ischemia; intracranial aneurysm; stroke