Most of the aneurysms occur at the bifurcation of major vessels as we all know. MCA aneurysms generally occur at bifurcation of MCA (MIDDLE CEREBRAL ARTERY) . However this aneurysm was at further branching of frontal division of MCA at M2-M3 junction and supplying frontal lobe . It posed a different challenges as aneurysm was embedded in frontal lobe paren chyma .
Also vessels beyond bifurcation are very delicate and frontal and temporal trunks generally trifurcate or more hence aneurysm is surrounded by multiple delicate 1-2mm vessels . Clipping some times carries risk of kinking these vessels . In this case aneurysm was bilobed and was clipped using two clips to avoid kinking of trifurcation. Patient had uneventful recovery.
CT ANGIO SHOWING RIGHT SIDED M2-M3 JUNCTION ANEURYSM.
