Giant pseudoaneurysm originated from distal middle cerebral artery dissection treated by trapping under sensitive evoked potential and motor evoked potential monitoring: Case report and discussion

BACKGROUND: Dissecting giant pseudoaneurysm of the middle cerebral artery (MCA) is a rare lesion often presenting challenges to neurosurgical teams dealing with this specific pathology. Giant pseudoaneurysm originating from a dissecting distal segment of the MCA treated with aneurysm trapping under motor and sensitive evoked potential monitoring with a successful outcome is presented in the article followed by a brief discussion on the subject. CASE DESCRIPTION: A case of a previously healthy young female patient admitted at the emergency room of Santa Paula Hospital with a history of a sudden headache and syncope, dysphasia, and Grade 4 right hemiparesis due to a large brain hemorrhage secondary to a 25 mm ruptured pseudoaneurysm originated from a distal left MCA dissecting segment is described. Because the patient risked neurological worsening, aneurysm was treated with parent and efferent vessel trapping technique and no changes on the sensitive and motor evoked potential (MEP) from baseline informed on this decision. Hemorrhage was completely drained after aneurysm was secured. CONCLUSION: Neurophysiological sensitive and MEP monitoring, on this specific case was a valuable tool and informed on the decision of trapping of this large vascular lesion.