Video Article Temporal Aneurysmorrhaphy Technique for the Management of Complex Middle Cerebral Artery Aneurysm: A Video Case Yuri Pilipenko and Arevik Abramyan Key words - Cerebral aneurysm - Clipping - Complex aneurysm - Middle cerebral artery - Surgical technique Abbreviations and Acronyms CT: Computed tomography DSA: Digital subtraction angiography MCA: Middle cerebral artery MRI: Magnetic resonance imaging Department of Neurovascular Surgery, N.N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia To whom correspondence should be addressed: Arevik Abramyan, M.D. [E-mail: dr.arevik.abramyan@gmail.com; abramyan@nsi.ru] Supplementary digital content available online. Citation: World Neurosurg. (2021) 148:196-197. https://doi.org/10.1016/j.wneu.2021.01.095 Journal homepage: www.journals.elsevier.com/worldneurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2021 Elsevier Inc. All rights reserved. Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Received 22 October 2020; accepted 21 January 2021 196 www.SCIENCEDIRECT.com A 57-year-old man who had previously suffered a transient episode of retrograde amnesia was admitted to the vascular department of the Burdenko Neurosurgical Center. Computed tomography angiography revealed a complex trifurcation aneurysm of the right middle cerebral artery (MCA) bifurcation. There were no clear focal symptoms after the neurologic examination. The patient underwent a right-sided craniotomy to approach the Sylvian fissure and MCA branches. The MCA aneurysm with 2 lobes had been exposed. One of the M2 branches densely adhered to the aneurysm dome. Attempts of the M2 separation along the dome stopped because there was a high risk of injury to the M2, the aneurysm, or both. To cutoff M2 without bleeding from the aneurysm, a curved clip was used, which we called an insulating clip. After this manipulation, it was already possible to try the neck closing with additional clips, however, according to manual sensations, we were not sure that the insulating clip would not shift and there would be no bleeding. The insulating clip interfered with the final clipping and should have been removed. Temporal aneurysmorrhaphy was used to ensure that the surgeon's manipulations were not complicated by bleeding. This also acted as a guarantee that, in the event of bleeding, the rupture would not spread to the neck of the aneurysm. Thus the M2 cutting-off with an insulating clip and temporal aneurysmorrhaphy were options that allowed for adequate final clipping. There were no intraoperative or postoperative complications. The patient remained neurologically intact and was discharged 7 days after surgery (Figure 1). Citation: World Neurosurg. (2021) 148:196-197. https://doi.org/10.1016/j.wneu.2021.01.095 Journal homepage: www.journals.elsevier.com/worldneurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2021 Elsevier Inc. All rights reserved. WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2021.01.095 VIDEO ARTICLE YURI PILIPENKO AND AREVIK ABRAMYAN TEMPORAL ANEURYSMORRHAPHY TECHNIQUE Figure 1. A step-by-step drawing of the technique. WORLD NEUROSURGERY 148: 196-197, APRIL 2021 www.journals.elsevier.com/world-neurosurgery 197