Multiple clips reconstruction for giant fusiform Middle Cerebral Artery aneurysm

•The Management of complex MCA aneurysms is an extremely challenging situation.•Whenever possible, clip reconstruction to preserve the anterograde flow would be ideal from the standpoint of perforators preservation.•Proximal clipping in conjunction with a distal bypass with retrograde flow maintained to the perforators might be the best choice.•Multiple clips reconstruction is a potential salvage surgical option for giant fusiform MCA aneurysms, whenever cerebral revascularization couldn’t be done.