[Surgical evacuation of an embolization coil from the middle cerebral artery]

We report the case of a 54-year-old woman with a right intracavernous internal carotid artery aneurysm treated endovascularly with MDS coils. During the procedure, one of the coils migrated to the middle cerebral artery (MCA), resulting in left hemiplegia. The attempt to remove the migrated coil endovascularly failed and the patient had emergency front-temporal craniotomy. After the dissection of the Sylvian fissure, the M1 portion of the MCA was exposed with the coil visible through the distended wall of the artery. Because it was feared that the M1 arteriotomy could tear the MCA, the coil was removed through the anterior temporal artery, a small branch of the M2 segment. Hemiplegia gradually resolved and the patient recovered completely. This case depicts an alternative route via a distal arteriotomy to remove the migrating coil. Additionally, it implies that endovascular procedures in neurosurgical patients should be performed by the interventional neurosurgeon (neurosurgeon trained to perform endovascular procedures) or at least with the support of a neurosurgical department for immediate intervention in the case of life-threatening complications.