Serpentine aneurysm of the middle cerebral artery: Case report

The serpentine aneurysm is an infrequent vascular anomaly, representing less than 0.1% of all aneurysms. It is defined by a substantial fusiform aneurysm exceeding 25 mm in diameter, frequently exhibiting partial thrombosis and maintaining a serpiginous vascular channel. This condition is associated with high morbidity and mortality rates, presenting considerable therapeutic challenges. Recent advancements in endovascular therapies have transformed the management of serpentine aneurysms, which are now considered the gold standard. These techniques incorporate both reconstructive and obstructive methods, often utilizing parent vessel occlusion testing to achieve favorable patient outcomes. This case report discusses a 39-year-old male presenting with headaches and right-sided transient paresthesia. Imaging, including computed tomography, revealed a partially thrombosed aneurysm in the left middle cerebral artery (MCA) region. Subsequent cerebral angiography confirmed serpentine opacification in the frontal M2 segment, characterized by sluggish flow terminating in a distal parent artery branch. The patient underwent elective embolization following parent vessel occlusion testing, which demonstrated retrograde filling of the cortical branch via a leptomeningeal anastomosis. Embolization involved the use of platinum coils to occlude both the aneurysm and its parent vessel. Postoperative recovery was uneventful, and the patient was discharged two days after the procedure. Understanding the unique angiographic features of serpentine aneurysms is crucial for effective management.