Giant fusiform aneurysm of the middle cerebral artery: successful Hunterian ligation without distal bypass

Giant fusiform aneurysm is a rare vascular lesion which presents difficult management issues. We describe one such aneurysm in a middle cerebral artery branch (M-2) that presented with subarachnoid haemorrhage and was managed operatively. Clinical, radiological and pathological presentations, as well as the different treatment options for this type of aneurysm are discussed based on a literature review. A satisfactory result in an Mt giant fusiform aneurysm can be achieved with Hunterian ligation of the parent vessel even when a distal EC-IC bypass is not possible.