Abstract
Fusiform or serpentine middle cerebral artery aneurysms remain challenging to treat and are often unsuitable for current endovascular techniques.1 Historically, surgical treatment strategies have included proximal vessel sacrifice, aneurysm trapping with anastomotic bypass, and clip reconstruction; more recently, endovascular treatments have been described in cases of favorable anatomy.1-4 Bypass procedures, both extracranialintracranial and intracranial-intracranial, remain a mainstay of treatment because of the ability to preserve perfusion to downstream parenchyma with obliteration of the aneurysm and have demonstrated favorable long-term patency rates.5 We present a case of a 72-year-old female who presented with left-sided Sylvian fissure subarachnoid hemorrhage due to a M2 fusiform aneurysm and demonstrate the operative technique for intracranial-intracranial (M2-M2) side-to-side bypass for trapping of this ruptured aneurysm and revascularization of the dominant hemisphere. The patient consented for surgery and photograph publication.