Temporary test occlusion of distal middle cerebral artery using GDC coil

The treatment of small distal intracranial aneurysms often requires parent vessel occlusion. However, this may be particularly challenging in patients in which the parent vessel serves eloquent brain. Superselective amytal testing is often conducted in these cases, but may prove unreliable or inconclusive. In order to more specifically assess the functional significance of the parent vessel in this patient with a distal left middle cerebral artery pseudoaneurysm who had failed superselective amytal testing, we used a Guglielmi Detachable coil to perform a temporary test occlusion. Testing was performed with the patient awake and examinable, and after no neurological changes were noted, the vessel was permanently occluded, successfully treating the aneurysm. To our knowledge, this is the first report to describe this unique method for assessing a parent vessel that previously had been thought to supply eloquent brain during amytal testing.