Intraoperative color-coded duplex sonography for localization of a distal middle cerebral artery aneurysm: technical case report.

OBJECTIVE AND

IMPORTANCE

We describe the surgical treatment of a small, distal, middle cerebral artery (MCA) aneurysm, performed using intraoperative color-coded duplex sonography for localization.

CLINICAL PRESENTATION: A 55-year-old man presented with a sudden intense headache. Computed tomographic scans revealed a subarachnoid hemorrhage. Angiography demonstrated two MCA aneurysms, one arising from the proximal bifurcation of the right MCA and the other from its distal bifurcation.

TECHNIQUE: On Day 1, the proximal MCA aneurysm was clipped via the standard transsylvian approach. The distal MCA aneurysm was identified with the aid of color-coded duplex sonography and was successfully clipped with minimal additional dissection of the sylvian fissure.

CONCLUSION

Color-coded duplex sonography provides a two-dimensional image of the brain parenchyma and color-coded flow imaging of cerebral vessels in real time. It may be used for rapid intraoperative localization of small, distally located, cerebral aneurysms.