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 arter y branch (M-2) that presented with subarachnoid haemorrhage and was managed operatively. Clinical, radiological and pathological presentations, as wel l as the different treatment options for this type of aneurysm are discusse d based on a literature review. A satisfactory result in an Mt giant fusifo rm aneurysm can be achieved with Hunterian ligation of the parent vessel ev en when a distal EC-IC bypass is not possible.