scholarly journals Clipping of Basilar and Middle Cerebral Artery Aneurysms: 2-dimensional operative video

2020 ◽  
Vol 19 (3) ◽  
pp. E290-E290
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Preoperative Planning ◽  
Video Recording ◽  
Surgical Clipping ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Complete Obliteration ◽  
Mca Aneurysm ◽  
Middle Cerebral Artery Aneurysms

Abstract Careful preoperative planning for patients with multiple intracranial aneurysms is paramount given the importance of an appropriate trajectory and exposure for each aneurysm that will be clipped. The general principle is to clip aneurysms in a retrograde manner, such that more distal aneurysms are clipped earlier, and more superficial aneurysms are clipped later. This patient had unruptured middle cerebral artery (MCA) and basilar artery (BA) apex aneurysms and elected for surgical clipping of both lesions. An orbitozygomatic craniotomy ipsilateral to the MCA aneurysm was performed to permit clipping of both lesions. The dissection initially focused on exposure of the MCA aneurysm and then focused on the carotid-oculomotor triangle to permit basilar apex exposure and aneurysm clipping. The MCA aneurysm was clipped second. Postoperative imaging demonstrated complete obliteration of both aneurysms. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Orbitozygomatic Craniotomy for Clipping a Complex Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (2) ◽  
pp. E33-E33
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Video Recording ◽  
Artery Aneurysm ◽  
Sylvian Fissure ◽  
Parent Artery ◽  
Parent Vessel ◽  
Institutional Review ◽  
Vessel Patency ◽  
Mca Aneurysm

Abstract Middle cerebral artery (MCA) aneurysms pose a surgical challenge because of the large caliber of the parent artery and the common need to dissect the sylvian fissure to permit access to the proximal and distal control. The neck of the aneurysm should be generously dissected to permit visualization of any adjacent lenticulostriate perforators. This patient demonstrated a left-sided wide-necked bilobed MCA aneurysm at the M1 bifurcation. The aneurysm was approached using a left orbitozygomatic craniotomy with distal sylvian fissure dissection. A single curved clip was applied for aneurysm occlusion, and postoperative angiography demonstrated aneurysm obliteration with parent vessel patency. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Image-Guided Surgery for Treatment of Unruptured Middle Cerebral Artery Aneurysms

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONS266-ONS272 ◽  
Author(s):  
Young-Je Son ◽  
Dae Hee Han ◽  
Jeong Eun Kim
Keyword(s):  
Minimally Invasive ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Image Guidance ◽  
Invasive Technique ◽  
Surgical Clipping ◽  
Guided Surgery ◽  
Image Guided ◽  
Mca Aneurysm ◽  
Middle Cerebral Artery Aneurysms

Abstract Objective: Direct surgical clipping appears to be an efficient means for managing unruptured middle cerebral artery (MCA) aneurysms, owing to several angioanatomic features. Here, we present a minimally invasive technique that uses navigation guidance for the treatment of unruptured MCA aneurysms. Methods: Between July of 2003 and June of 2005, we used image-guidance navigation to operate on 24 patients who were diagnosed with unruptured MCA aneurysm. Five men and 19 women were included in the study, and their ages ranged from 43 to 70 years (mean, 58 yr). We predetermined the transsylvian trajectory toward the aneurysm and planned a tailored craniotomy for each patient. Results: All aneurysms were readily identified and successfully clipped via craniotomies of less than 3 cm in diameter. We experienced no surgical complications, and each patient had an uneventful postoperative course. Conclusion: With the aid of navigation, we were able to easily locate MCA aneurysms and perform minimally invasive surgeries such as mini-craniotomies, tailored sylvian dissections, and successful clippings of unruptured MCA aneurysms. In addition, we obtained satisfactory cosmetic results.

scholarly journals Surgical management of middle cerebral artery aneurysms

2019 ◽  
pp. 23-30
Author(s):  
Mugurel Radoi ◽  
Florin Stefanescu ◽  
Ram Vakilnejad
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cerebral Aneurysms ◽  
Patient Characteristics ◽  
Surgical Clipping ◽  
Excellent Outcome ◽  
Operative Control ◽  
Mca Aneurysm ◽  
Middle Cerebral Artery Aneurysms

Background. The middle cerebral artery (MCA) harbors approximately 14% to 30% of all ruptured cerebral aneurysms. They can occur at multiple sites throughout the course of the middle cerebral artery, but most often are found at the bifurcation of the first segment (M1). Methods. A retrospective review of 116 consecutive patients with an MCA aneurysm treated by surgical clipping, by two senior neurosurgeons, was performed. The data of all our consecutive patients were searched to obtain patient characteristics, details of the aneurysm size and orientation, treatment details, complications and follow up. At admission, the clinical condition of all patients was classified according to the Hunt and Hess scale. Clinical outcome was graded according to the modified Rankin scale. The follow-up period varied widely from 2 to 72 months (mean 30 months). Results. Surgical clipping was performed for 113 ruptured MCA aneurysms; only in 3 cases the aneurysm was unruptured. Fourteen patients presented with significant hematoma which required the evacuation of the clot. Post-operative control angiography was performed in 32 patients (27.5%), from which we reported a full occlusion of the aneurysm in 32 patients (93.75%). Perioperative mortality was 5.2% (6 patients), due to neurological (4 patients) or systemic causes (2 patients).  The outcome was graded mRankin 0–2 in 72.5% of the cases (84 patients) at the end of the first postoperative months, and 78.5% (91 patients) at six months follow-up. The most important improvement was recorded for patients graded mRankin 1-2 at the first month follow-up. All 3 patients with a surgically treated asymptomatic MCA aneurysm had an excellent outcome (mRS 0) at both follow-up, 1 months and respectively 6 months. Conclusions. For the experienced neurovascular team, MCA aneurysms currently make microsurgical treatment the preferred treatment modality for most MCA aneurysms.

scholarly journals Left Retrosigmoid Craniotomy for Resection of Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (1) ◽  
pp. E2-E2
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Preoperative Planning ◽  
Cavernous Malformation ◽  
Video Recording ◽  
Close Inspection ◽  
Middle Cerebellar Peduncle ◽  
Cavernous Malformations ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Surgical Field ◽  
Cerebellar Peduncle

Abstract Pontine cavernous malformations are highly morbid lesions that require thorough preoperative planning of the surgical approach and meticulous surgical technique to successfully remove. The patient in this case has a large pontine cavernous malformation coming to the parenchymal surface along the pontine–middle cerebellar peduncle interface. The depth of the surgical field and narrow trajectory of approach require use of lighted suction, lighted bipolar forceps, and stereotactic neuronavigation to successfully locate and remove the entire lesion. The cavernous malformation is removed in a piecemeal manner with close inspection of the resection cavity for any remnants. Postoperative imaging demonstrates gross total resection of the lesion. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Endovascular and Surgical Options for Ruptured Middle Cerebral Artery Aneurysms: Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
David R. Santiago-Dieppa ◽  
Jeffrey S. Pannell ◽  
Alexander A. Khalessi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Review Of The Literature ◽  
Surgical Options ◽  
Mca Aneurysm ◽  
Middle Cerebral Artery Aneurysms

Middle cerebral artery (MCA) aneurysms are common entities, and those of the bifurcation are the most frequently encountered sublocation of MCA aneurysm. MCA bifurcation (MBIF) aneurysms commonly present with subarachnoid hemorrhage (SAH), are devastating, and are often lethal. At the present time, the treatment of ruptured MBIF aneurysms entails either endovascular or open microneurosurgical methods to permanently secure the aneurysm(s). The purpose of this report is to review the current available data regarding the relative superiority of endovascular versus open microneurosurgical clipping for the treatment of ruptured middle cerebral artery bifurcation aneurysms.

scholarly journals Cervical 3 to Cervical 6 Laminectomy for Arteriovenous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (5) ◽  
pp. E200-E200
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Arteriovenous Malformation ◽  
Surgical Resection ◽  
Video Recording ◽  
Institutional Review Board ◽  
Digital Subtraction ◽  
Pia Mater ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Complete Obliteration ◽  
System 1

Abstract According to the Spetzler spinal cord classification system,1 this patient had an extradural-intradural arteriovenous malformation (AVM), also known as a type III or juvenile AVM. The patient underwent a surgical resection of the lesion via a cervical 3 to cervical 6 laminoplasty. Direct observation confirmed intra- and extramedullary components. During the surgical resection, an attempt was made to avoid transgressing the pia mater. Therefore, the traversing vessels were interrupted during the circumdissection. The nidus was removed, and postprocedural digital subtraction angiography confirmed complete obliteration. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Surgical management of complex middle cerebral artery aneurysms: An institutional review

2020 ◽  
Vol 15 (4) ◽  
pp. 959
Author(s):  
AnujArun Bhide ◽  
Yashuhiro Yamada ◽  
Yoko Kato ◽  
Tsukasa Kawase ◽  
Riki Tanaka ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Surgical Management ◽  
Cerebral Artery ◽  
Institutional Review ◽  
Middle Cerebral Artery Aneurysms

scholarly journals Left Modified Orbitozygomatic Approach for Clipping of Multilobulated Middle Cerebral Artery Bifurcation Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E386-E386 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Video Recording ◽  
Parent Vessel ◽  
Microsurgical Treatment ◽  
Institutional Review ◽  
Bifurcation Aneurysm ◽  
Orbitozygomatic Approach ◽  
Clip Application ◽  
Clip Occlusion

Abstract Middle cerebral artery (MCA) aneurysms are associated with one of the most favorable approaches for microsurgical treatment; however, aneurysm geometrics can pose challenges during clip application. The surgeon must be mindful of the clip configuration options available during the planning of ideal clip occlusion for irregular or multilobulated aneurysm domes. This patient had an incidental multilobulated MCA bifurcation aneurysm and underwent an orbitozygomatic approach for microsurgical treatment. Proximal and distal control of the aneurysm were achieved, and complete clip occlusion was achieved following the placement of a single permanent clip. Flow within the parent vessel was well preserved, and complete aneurysm occlusion was achieved. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Moyamoya Disease Superficial Temporal Artery-to-Middle Cerebral Artery Onlay: 2-Dimensional Operative Video

2020 ◽  
Vol 18 (6) ◽  
pp. E229-E229
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Video Recording ◽  
Temporal Artery ◽  
Low Flow ◽  
Institutional Review ◽  
Direct Anastomosis

Abstract The most frequently performed low-flow bypass procedure is the superficial temporal artery (STA) to middle cerebral artery (MCA) bypass. If available, a suitable M2 or M3 cortical branch is anastomosed to the donor vessel. This patient had severe moyamoya disease with an ipsilateral perfusion deficit and transient ischemic attacks. Given the need for revascularization, an STA-to-MCA bypass was performed. There was no suitable recipient M3 branch for direct anastomosis, and therefore an indirect bypass was performed by onlaying the STA onto the cortical surface and suturing the adventitia of the STA to the arachnoid of the underlying cortex. The dural leaflets were then inverted to potentiate further revascularization of the underlying cortex. The patient remained at their neurological baseline and demonstrated an enhanced perfusion of the ipsilateral MCA territory on follow-up evaluation. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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