How I do it: coil extraction and clip reconstruction of a previously coiled giant middle cerebral artery aneurysm.

BACKGROUND: Microsurgical clipping of previously coiled intracranial aneurysms can be technically challenging. We present the case of a 48-year-old female with a partially coiled, previously ruptured giant middle cerebral artery aneurysm and the associated technical nuances. METHODS: We performed a successful coil extraction and clip reconstruction of this aneurysm using an ultrasonic aspirator and stacked fenestrated aneurysm clips. CONCLUSION: Coil extraction and clip occlusion of previously coiled intracranial aneurysms is a complex and technically challenging procedure but can be performed safely and effectively when employed judiciously.