• Giacomo Pavesi, Stavros Dimitriadis, Stefano Baroni, Stefano Vallone, Franco Valzania, Giovanni Battista Costella, and Alberto Feletti.
• Department of Neurosurgery, NOCSAE Modena Hospital, Modena, Italy.
• World Neurosurg. 2015 Aug 1;84(2):592.e15-21.

BackgroundGiant serpentine aneurysms are a rare entity, which can be managed using either endovascular or surgical techniques. Although the perioperative morbidity and mortality have decreased since the development of bypass revascularization procedures, their surgical treatment is still challenging. Intraoperative functional and perfusion monitoring techniques can be precious to make better decisions and improve outcomes.Case DescriptionWe report on the case of a giant, unruptured, partially thrombosed, serpentine middle cerebral artery aneurysm that was treated with partial endovascular coiling of intra-aneurysmal vascular channels, surgical resection of the aneurysm, and end-to-end M1-temporal M2 anastomosis.ConclusionsIntraoperative continuous motor evoked potentials monitoring, flowmetry, and indocyanine-green angiography provide precise and reproducible information about cerebral function and perfusion, respectively, allowing for more rational decision making during surgery for these challenging malformations.Copyright © 2015 Elsevier Inc. All rights reserved.

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