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(a) CT angiogram demonstrates the complexity of the lesion and relationship of the neck to arterial branches. At the time of surgery, multiple clip applications were attempted with intraoperative angiographic guidance. The aneurysm could not be completely obliterated with maintenance of patency of all branches. With intraoperative interventional neuroradiology consultation, we elected to partially clip the aneurysm and create a smaller neck that was amenable to endovascular coiling (b). Final intraoperative angiogram shows small residual aneurysm that was obliterated by endovascular coiling several days after surgery (c).

(a) CT angiogram demonstrates the complexity of the lesion and relationship of the neck to arterial branches. At the time of surgery, multiple clip applications were attempted with intraoperative angiographic guidance. The aneurysm could not be completely obliterated with maintenance of patency of all branches. With intraoperative interventional neuroradiology consultation, we elected to partially clip the aneurysm and create a smaller neck that was amenable to endovascular coiling (b). Final intraoperative angiogram shows small residual aneurysm that was obliterated by endovascular coiling several days after surgery (c).