Giant serpentine aneurysms are rare, partially thrombosed, fusiform aneurysms exceeding 25 mm in diameter, characterized by tortuous intra-aneurysmal vascular channels. These lesions present with significant morbidity due to mass effect and vascular compromise, posing diagnostic and therapeutic challenges. We report a case of a 22-year-old female presenting with dizziness, headaches, diplopia, and blurred vision. CT imaging revealed a giant serpentine aneurysm of the right middle cerebral artery (MCA) with multiple lobulated sacs and peripheral thrombosis. Endovascular treatment with a flow-diverting stent and coil embolization was performed successfully. Postprocedural imaging confirmed complete exclusion of the aneurysm from circulation with preserved vessel patency. The patient remained neurologically intact with stable imaging findings on six-month follow-up. This case highlights the importance of multimodal imaging and individualized therapeutic strategies, also the efficacy and safety of flow-diverting stents in treating complex giant serpentine aneurysms. A literature review on their pathogenesis, clinical presentation, imaging characteristics, and management is also provided.
Tatjana Antonic Trebovac (Thu,) studied this question.