Serpentine Aneurysm

Giant serpentine aneurysms (GSAs) are infrequent. We present a 37-year-old patient with a giant serpentine aneurysm of the left middle cerebral artery that was treated with a superficial temporal artery to middle cerebral artery bypass and ligature of the left internal carotid artery. After 2 years, the patient presented new symptoms of neurological deterioration and the computed tomographic scan and arteriography showed regrowth of the aneurysm, which was excised. Enlargement of a giant serpentine aneurysm once it has been treated with ipsilateral carotid ligation and/or bypass anastomosis is rare, and only two cases have been described previously.