First Endovascular Flow Diversion Treatment for a Supergiant Brain Aneurysm (>110 mm) in Ethiopia

In late 2022, a 65‐year‐old woman presented to us with a 3‐day history of ischemic stroke resulting in left facial droop and left‐sided weakness. She had a known giant right internal carotid artery (ICA) aneurysm since 2015 that kept on growing and causing her a myriad of neurologic signs and symptoms including recurrent severe headaches, debilitating tinnitus, right‐sided vision loss (2020), proptosis, ophthalmoplegia, ptosis, and hearing loss. She had allodynia in the right trigeminal nerve distribution, complete right facial palsy, new left lower facial palsy and left hemiparesis (3/5 strength). Unfortunately, local treatment options were unavailable at that time, and she could not afford treatment abroad. Serial brain imaging revealed a continuously enlarging right ICA aneurysm, exceeding 110 mm in size, which to our knowledge, is the largest reported brain aneurysm thus far. Flow diverter embolization of the aneurysm was performed 2 weeks later, resulting in the complete resolution of her debilitating tinnitus and headaches.