Parent artery encroachment after clipping of kissing middle cerebral artery bifurcation aneurysm: A case report
10.7461/jcen.2025.E2025.08.002
- Author:
Changheon KIM
1
;
HyoJun KIM
;
Taesik SONG
;
Seung Kon HUH
Author Information
1. Presbyterian Medical Center, Jeonju, Korea
- Publication Type:Case Report
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2026;28(1):77-82
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:Kissing middle cerebral artery bifurcation aneurysms (KMCBA) are rare vascular lesions. Their complex morphology and limited surgical experience may predispose patients to devastating complications.Cases: Among 100 patients who underwent microsurgical clipping for cerebral aneurysms between May 2022 and April 2025, two were diagnosed with unruptured KMCBA. In Case 1, the two aneurysm sacs of a left KMCBA were clipped separately using interlocking and fenestrated clips without premature rupture. In Case 2, both aneurysm sacs of a right KMCBA were clipped simultaneously with a long J-shaped clip. Postoperatively, the patient developed left hemiparesis due to clip-induced encroachment of the superior trunk of M2. Revision clipping with a shorter L-shaped clip restored flow, and the patient was discharged with a modified Rankin scale (mRS) score of 4.
Conclusions:Successful microsurgical clipping of KMCBA requires meticulous surgical strategies to avoid parent artery encroachment, including separate clipping of each aneurysm neck whenever feasible, appropriate clip selection, and the use of multimodal intraoperative anatomical and physiological monitoring.
