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.

Subarachnoid hemorrhage secondary to ruptured aneurysms in infants

1978 ◽  
Vol 49 (6) ◽  
pp. 898-902 ◽  
Author(s):  
Marshall L. Grode ◽  
Myles Saunders ◽  
Charles A. Carton
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Case Histories ◽  
Content Type ◽  
Ruptured Aneurysms ◽  
Detailed Case ◽  
Subarachnoid Bleeding ◽  
Middle Cerebral Artery Aneurysms ◽  
Fine Print

✓ Two infants with subarachnoid bleeding from middle cerebral artery aneurysms are presented, with detailed case histories.

Microsurgical and Angiographic Anatomy of Middle Cerebral Artery Aneurysms: Prevalence and Significance of Early Branch Aneurysms

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS344-ONS353 ◽  
Author(s):  
Arthur J. Ulm ◽  
Gregory L. Fautheree ◽  
Necmettin Tanriover ◽  
Antonino Russo ◽  
Erminia Albanese ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Retrospective Review ◽  
Intracerebral Hematoma ◽  
Aneurysm Neck ◽  
Average Patient ◽  
Ischemic Complications ◽  
Middle Cerebral Artery Aneurysms ◽  
Frontal Branch

Abstract Objective: To determine the prevalence of early branch aneurysms, characterize these lesions angiographically and anatomically, and determine their clinical significance. Methods: The authors conducted a retrospective review of 125 consecutive patients with a diagnosis of middle cerebral artery (MCA) aneurysm. Eighty-four patients harboring 100 MCA aneurysms were studied; 41 patients were excluded for lack of adequate imaging or for fusiform morphology of the aneurysm. Demographic characteristics including age, side, sex, subarachnoid hemorrhage, intracerebral hematoma, multiple aneurysms, and type of treatment were obtained. Results: The average patient age was 57.3 years (range, 29–79 yr); 69 were women and 15 were men. Fifty-eight were right MCA aneurysms and 42 were left aneurysms. Fourteen patients had multiple MCA aneurysms. Thirty-nine of 100 aneurysms were associated with subarachnoid hemorrhage. Twelve of 100 aneurysms were associated with an intracerebral hematoma. The average aneurysm sizes were 9.1 mm overall (range, 2.0–27.0 mm), 12.3 mm for ruptured aneurysms, and 7.5 mm for unruptured. There were 36 M1 bifurcation aneurysms, 39 early frontal branch aneurysms, 18 early temporal branch aneurysms, four lenticulostriate artery aneurysms, and three trifurcation aneurysms. Conclusion: In our retrospective review, the majority of MCA aneurysms arose along the M1 segment proximal to the M1 bifurcation. Early frontal branch aneurysms were more common than typical M1 segment bifurcation aneurysms. M1 segment aneurysms arising from early frontal and early temporal branches have distinct anatomic features that impact surgical management and outcome. Understanding the relationship between the recurrent lenticulostriate arteries arising from the proximal segments of these early branches and the aneurysm neck should allow surgeons to avoid many postoperative ischemic complications when dealing with these challenging lesions.

Coil Embolization of Unruptured Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. 346-354 ◽  
Author(s):  
Byung Moon Kim ◽  
Dong Ik Kim ◽  
Sung Il Park ◽  
Dong Joon Kim ◽  
Sang Hyun Suh ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Primary Treatment ◽  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
Unruptured Aneurysms ◽  
Permanent Morbidity ◽  
Middle Cerebral Artery Aneurysms

Abstract BACKGROUND: Since the International Subarachnoid Aneurysmal Trial, endovascular coiling has been increasingly used as primary treatment option for ruptured or unruptured aneurysms that are feasible for coiling. OBJECTIVE: To evaluate the feasibility and clinical and angiographic outcomes of coiling for unruptured middle cerebral artery aneurysms. METHODS: The records of 70 consecutive patients with 76 unruptured middle cerebral artery aneurysms who underwent coiling were retrospectively evaluated. RESULTS: Thirty-one aneurysms were treated by single-catheter, 18 by multicatheter, 11 by balloon-assisted, 13 by stent-assisted, and 3 by a combination of multicatheter and balloon-assisted techniques. Coiling was accomplished in 75 but failed in 1 aneurysm. One patient died of consequences of subarachnoid hemorrhage occurring 9 hours after coiling. One intraprocedural aneurysm rupture occurred, which was controlled by further coil insertions and left no sequelae. There were 1 cortical infarction and 1 basal ganglia infarction, both of which recovered completely. Treatment-related permanent morbidity and mortality rates were 0% and 1.4%, respectively. Postembolization control angiography revealed 40 complete, 30 neck remnant, and 5 incomplete occlusions. Clinical follow-up was available in all patients (mean, 25 months; range, 7-105 months). There was no subarachnoid hemorrhage during follow-up, but 1 death resulting from acute myocardial infarction occurred 3 months after coiling. None of the surviving patients had any neurological deterioration. Follow-up angiography was available in 69 aneurysms at 6 to 24 months (mean, 12 months). Three major and 6 minor recurrences were detected. All 3 major recurrent aneurysms were re-treated by coiling without any complications. CONCLUSION: Most unruptured middle cerebral artery aneurysms could be safely treated by coiling with acceptable short-term to midterm outcomes. Our results warrant further study with a longer follow-up period in a larger population.

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.

Sequential Coiling-Assisted Deployment of Flow Diverter for Treatment of Fusiform Middle Cerebral Artery Aneurysms

2017 ◽  
Vol 15 (2) ◽  
pp. E13-E18 ◽  
Author(s):  
Abdulrahman Y Alturki ◽  
Philip G R Schmalz ◽  
Christopher S Ogilvy ◽  
Ajith J Thomas
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Vascular Anatomy ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Anterior Circulation ◽  
Vertebrobasilar System ◽  
Middle Cerebral Artery Aneurysms ◽  
Vessel Reconstruction

Abstract BACKGROUND AND IMPORTANCE Fusiform intracranial aneurysms remain challenging lesions to treat. These aneurysms have historically required bypass procedures or clip remodeling constructs for cure. Recently, endovascular specialists have reported experience with flow diversion for complex fusiform aneurysms of the vertebrobasilar system, with mixed results. Vascular anatomy for anterior circulation fusiform aneurysms may make these lesions more amenable to flow diversion and embolization procedures; however, published experience with these techniques is lacking. In this report, we describe a sequential coiling-assisted deployment of flow diverter for the treatment of fusiform middle cerebral artery (MCA-M1) aneurysms in 2 cases, 1 presenting acutely with subarachnoid hemorrhage and another with progressive aneurysm enlargement. CLINICAL PRESENTATION Two patients, a 36-yr-old male presenting with subarachnoid hemorrhage and a 60-yr-old female presenting with aneurysm enlargement were treated for fusiform aneurysms of the M1 segment of the MCA using a sequential, partial deployment of coils and flow diverter through 2 microcatheters to facilitate mutual mechanical support for both coil and flow diverter (Pipeline Embolization Device; Medtronic Inc, Dublin, Ireland). Both patients achieved favorable outcomes and follow-up angiography demonstrated complete vessel reconstruction in both cases. CONCLUSION The treatment of complex, fusiform, large vessel aneurysms remains challenging. As experience with new endovascular technologies and techniques grows, these lesions may be treated safely with interventional methods. The technique of partial flow diverter deployment and stabilization with coils with sequential delivery of both devices using dual microcatheter was both safe and effective.

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 Bypass surgery for complex middle cerebral artery aneurysms: an algorithmic approach to revascularization

2017 ◽  
Vol 127 (3) ◽  
pp. 463-479 ◽  
Author(s):  
Ali Tayebi Meybodi ◽  
Wendy Huang ◽  
Arnau Benet ◽  
Olivia Kola ◽  
Michael T. Lawton
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Algorithmic Approach ◽  
Complex Aneurysms ◽  
Bypass Patency ◽  
Mca Aneurysm ◽  
In Situ Bypass ◽  
Middle Cerebral Artery Aneurysms

OBJECTManagement of complex aneurysms of the middle cerebral artery (MCA) can be challenging. Lesions not amenable to endovascular techniques or direct clipping might require a bypass procedure with aneurysm obliteration. Various bypass techniques are available, but an algorithmic approach to classifying these lesions and determining the optimal bypass strategy has not been developed. The objective of this study was to propose a comprehensive and flexible algorithm based on MCA aneurysm location for selecting the best of multiple bypass options.METHODSAneurysms of the MCA that required bypass as part of treatment were identified from a large prospectively maintained database of vascular neurosurgeries. According to its location relative to the bifurcation, each aneurysm was classified as a prebifurcation, bifurcation, or postbifurcation aneurysm.RESULTSBetween 1998 and 2015, 30 patients were treated for 30 complex MCA aneurysms in 8 (27%) prebifurcation, 5 (17%) bifurcation, and 17 (56%) postbifurcation locations. Bypasses included 8 superficial temporal artery–MCA bypasses, 4 high-flow extracranial-to-intracranial (EC-IC) bypasses, 13 IC-IC bypasses (6 reanastomoses, 3 reimplantations, 3 interpositional grafts, and 1 in situ bypass), and 5 combination bypasses. The bypass strategy for prebifurcation aneurysms was determined by the involvement of lenticulostriate arteries, whereas the bypass strategy for bifurcation aneurysms was determined by rupture status. The location of the MCA aneurysm in the candelabra (Sylvian, insular, or opercular) determined the bypass strategy for postbifurcation aneurysms. No deaths that resulted from surgery were found, bypass patency was 90%, and the condition of 90% of the patients was improved or unchanged at the most recent follow-up.CONCLUSIONSThe bypass strategy used for an MCA aneurysm depends on the aneurysm location, lenticulostriate anatomy, and rupture status. A uniform bypass strategy for all MCA aneurysms does not exist, but the algorithm proposed here might guide selection of the optimal EC-IC or IC-IC bypass technique.

Minimally Invasive Transpalpebral ‘‘Eyelid’’ Approach to Unruptured Middle Cerebral Artery Aneurysms

2017 ◽  
Vol 13 (4) ◽  
pp. 453-464 ◽  
Author(s):  
Mauricio Mandel ◽  
Rafael Tutihashi ◽  
Suzana Abramovicz Mandel ◽  
Manoel Jacobsen Teixeira ◽  
Eberval Gadelha Figueiredo
Keyword(s):  
Minimally Invasive ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
New Approach ◽  
Technological Advances ◽  
The Mean ◽  
Mca Aneurysm ◽  
Middle Cerebral Artery Aneurysms ◽  
Prospective Database

Abstract BACKGROUND: Although recent technological advances have led to successful endovascular treatment, middle cerebral artery (MCA) aneurysms are still prone to surgery. Because minimally invasive options are limited and possess several functional and cosmetic drawbacks, a transpalpebral approach is proposed as a new alternative. OBJECTIVES: To describe and assess surgical results of the minimally invasive transpalpebral approach in patients with MCA aneurysms. METHODS: The data of 25 patients with unruptured MCA aneurysms from 2013 to 2016 were included in a cohort prospective database. We describe modifications of the approach and technique for MCA aneurysm clipping, in a step-by-step manner. The outcome was based on complications, procedural morbidity and mortality, and clinical and angiographic outcomes. RESULTS: All procedures were successfully performed in a standardized way, and no major complications related to the new approach were observed. Twenty-two patients were discharged the day after surgery (88%). The majority of aneurysms were 5 to 6 mm in diameter (mean, 7 mm; range 4-21 mm). All patients underwent postoperative angiographic control, which showed no significant residual neck. A 3-mo follow-up was sufficient to show no visible scars with excellent cosmetic results. The mean duration of follow-up was 16 mo. CONCLUSION: The transpalpebral approach comes as a minimally invasive, safe, definitive, and cosmetically adequate solution for MCA aneurysms at the present time.

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