Middle cerebral artery occlusion after pterional approach to basilar bifurcation aneurysm: Technical case report

OBJECTIVE AND IMPORTANCE: The authors present a case of a subacute middle cerebral artery occlusion that was sustained subsequent to a basilar apex aneurysm clipping via the pterional approach. A middle cerebral artery stroke is a rare complication of basilar bifurcation aneurysm clipping, and, to our knowledge, this complication has not been previously described in otherwise healthy patients with unruptured basilar aneurysms. CLINICAL PRESENTATION: A 36-year-old woman was found to have an unruptured 1.6 x 1.0- cm basilar tip aneurysm, as revealed by computed tomography. She elected to undergo surgical repair. TECHNIQUE: Transsylvian dissection, exposure, and uneventful clipping of the basilar bifurcation aneurysm were performed. CONCLUSIONS: A middle cerebral artery stroke occurring after the repair of an intact basilar aneurysm has several possible causes, including retraction injury and direct surgical injury. Awareness of this complication is important for the early recognition and management of the occlusion before infarction is established.