Surgical nuances of clip reconstruction of recurrent middle cerebral artery aneurysms: A technical note

Recurrence of an aneurysm is not frequently seen after microsurgical clipping. The exact incidence is varied among studies related to recurrent aneurysms from 0.02% to 0.52%. A 68-year-old male, diagnosed with unruptured left middle cerebral artery (MCA) aneurysm 8 years back, was treated by microsurgical clipping then. He was on periodic follow-up since. On yearly follow-up, in 2015, magnetic resonance imaging/magnetic resonance angiography showed small recurrent aneurysm. This was followed up with serial imaging, and the aneurysm slowly grew in size. 2 years after, he was found to have a recurrent aneurysm; in 2017, he was operated for the recurrent aneurysm with microsurgical clipping. Here, we report the technical difficulties and strategies to approach recurrent MCA aneurysm.