Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

Abstract OBJECTIVE Because of their anatomic configuration, middle cerebral artery (MCA) aneurysms are most often treated with surgical clipping. However, endovascular coil embolization of these aneurysms is an increasingly used alternative. We retrospectively reviewed the anatomic and clinical outcomes of patients with MCA aneurysms who underwent endovascular treatment at our institution. METHODS One hundred fifteen MCA aneurysms in 115 patients (mean age, 55.1 years) were treated by an endovascular technique from April 1990 to March 2007. Forty-eight patients (42%) presented with acute subarachnoid hemorrhage, and 67 patients (58%) had unruptured aneurysms. Fifty-three aneurysms (46%) were small with a small neck, 28 (24%) were small with a wide neck, 22 (19%) were large, and 12 (11%) were giant. RESULTS Angiographic results immediately after embolization showed complete occlusion in 53 aneurysms (46%), a neck remnant in 51 (44%), and incomplete occlusion in 3 (3%). Because of anatomic difficulties, we could not embolize 8 aneurysms (7%). Thirteen patients underwent combined treatment that included endovascular and extracranial-intracranial bypass surgery. Morbidity and mortality rates were 6.9% (8 patients) and 3% (3 patients), respectively. Procedure-related complications were encountered in 10 patients (9%). Seventy patients had long-term follow-up angiograms. Seven aneurysms (10%) were recanalized; all were large or giant. One partially embolized large aneurysm ruptured 13 months after embolization. CONCLUSION In this series, endovascular coil embolization of MCA aneurysms has morbidity and mortality rates comparable to those of conventional surgical clipping. Combined treatment of endovascular and bypass surgery can successfully treat large or giant complex fusiform MCA aneurysms.

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

Operative Neurosurgery ◽

10.1227/01.neu.0000303979.88880.06 ◽

2007 ◽

Vol 61 (suppl_5) ◽

pp. ONS266-ONS272 ◽

Cited By ~ 9

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.

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Surgical clipping of a large left middle cerebral artery aneurysm

Neurosurgical FOCUS ◽

10.3171/2015.v1.focus14555 ◽

2015 ◽

Vol 38 (videosuppl1) ◽

pp. Video13

Author(s):

M. Yashar S. Kalani ◽

Peter Nakaji ◽

Joseph M. Zabramski ◽

Robert F. Spetzler

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Artery Aneurysm ◽

Left Middle Cerebral Artery ◽

Middle Cerebral Artery Aneurysm ◽

Surgical Clipping ◽

Microsurgical Clipping ◽

Middle Cerebral Artery Aneurysms ◽

Cerebral Artery Aneurysm ◽

Left Middle

Middle cerebral artery aneurysms, especially those with complex morphology, are considered excellent aneurysms for surgical clipping, given the challenges that exist with current endovascular techniques. We present a case of a large, complex, left middle cerebral artery aneurysm treated with microsurgical clipping. This video highlights critical steps in obtaining proximal and distal control as well as subarachnoid dissection necessary to prepare the aneurysm for final clipping.The video can be found here: http://youtu.be/RlKH2Km9z5Y.

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Ruptured Middle Cerebral Artery Aneurysms: Retrospective Study and Multivariate Analysis of 105 Patients Treated by Surgical Clipping

Journal of Neurosurgery Research and Reviews ◽

10.36959/363/405 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

Ruggeri Andrea Gennaro ◽

Fazzolari Benedetta ◽

Bartolomeo Alessandro Di ◽

Iacopino Giorgia ◽

Cappelletti Martina ◽

...

Keyword(s):

Multivariate Analysis ◽

Retrospective Study ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Surgical Clipping ◽

Middle Cerebral Artery Aneurysms

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Surgical Clipping of Middle Cerebral Artery Aneurysms on the Medial Side of the Limen Insulae (Medial Insulae Aneurysm)

Surgery for Cerebral Stroke ◽

10.2335/scs.46.111 ◽

2018 ◽

Vol 46 (2) ◽

pp. 111-116

Author(s):

Taku OKUBO ◽

Kana FUJIMORI ◽

Natsuko ITO ◽

Yui NAGATA ◽

Kei NOGUCHI ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Surgical Clipping ◽

Medial Side ◽

Middle Cerebral Artery Aneurysms

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Partially thrombosed middle cerebral artery-lenticulostriate artery aneurysm with native radiological examinations suggesting proximal lenticulostriate artery aneurysm: A case report

Surgical Neurology International ◽

10.25259/sni_597_2021 ◽

2021 ◽

Vol 12 ◽

pp. 389

Author(s):

Mitsuhiro Anan ◽

Yasuyuki Nagai ◽

Takeshi Matsuda ◽

Kazuya Morimoto ◽

Minoru Fujiki

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Unusual Case ◽

Artery Aneurysm ◽

Endovascular Embolization ◽

Surgical Clipping ◽

Appropriate Treatment ◽

Proximal Middle Cerebral Artery ◽

Lenticulostriate Artery ◽

Radiological Examinations

Background: Preservation of the lenticulostriate artery (LSA) is crucial. LSAs usually cannot be spared with LSA aneurysms, when surgical clipping/excision or endovascular embolization of the LSA itself is performed. On the other hand, the LSA should be separated and preserved for proximal middle cerebral artery (M1)-LSA aneurysms. Case Description: We report a case of M1-LSA aneurysm with native radiological examinations suggesting LSA aneurysm. The highlight of this unusual case was that during surgery, the aneurysm orifice was almost covered with thrombus and blood flow in an aneurysm that appeared separate from M1. Partial thrombectomy-clip reconstruction was performed, and M1 and LSAs were well preserved. Conclusion: Even with currently developed radiological modalities, thrombosed intracranial aneurysms may be misdiagnosed, depending on intraluminal flow conditions. Intraoperative findings from craniotomy sometimes contribute to a better understanding of the pathophysiology and decisions on appropriate treatment strategy.

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Growth and Spontaneous Regression of a Middle Cerebral Artery Aneurysm after Surgical Clipping

Interventional Neuroradiology ◽

10.1177/159101990100700210 ◽

2001 ◽

Vol 7 (2) ◽

pp. 147-151 ◽

Cited By ~ 1

Author(s):

C.B. Tan ◽

G. Rodesh ◽

P. Lasjaunias

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Spontaneous Regression ◽

Artery Aneurysm ◽

Middle Cerebral Artery Aneurysm ◽

Surgical Clipping ◽

Complete Obliteration ◽

Grade Ii ◽

Partial Thrombosis ◽

Cerebral Artery Aneurysm

We present a case of growth and spontaneous regression of a middle cerebral artery aneurysm after surgical clipping. A 36-year-old woman who presented with grade II subarachnoid haemorrhage was found to have a right middle cerebral artery aneurysm. The aneurysm was surgically clipped in view of the morphology of the aneurysm. Second clipping was performed four months later as there was re-growth of the neck of the aneurysm. Again re-growth of the aneurysm was noted five months after the second clipping. As further clipping of the aneurysm would be difficult, external and internal carotid arteries bypass was the treatment option but unfortunately, the by-pass operation was unsuccessful. Interestingly, angiogram performed after the bypass surgery revealed partial thrombosis and decreasing size of the aneurysm. Complete obliteration of the aneurysm was noted without further intervention one month after the failed by-pass surgery.

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

Operative Neurosurgery ◽

10.1093/ons/opaa116 ◽

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.

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Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: a consecutive series

Journal of Neurosurgery ◽

10.3171/jns.1999.90.6.1025 ◽

1999 ◽

Vol 90 (6) ◽

pp. 1025-1030 ◽

Cited By ~ 110

Author(s):

Luca Regli ◽

Antoine Uske ◽

Nicolas de Tribolet

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Primary Treatment ◽

Treatment Recommendation ◽

Consecutive Series ◽

Surgical Clipping ◽

Efficient Treatment ◽

Content Type ◽

Unruptured Aneurysms ◽

Fine Print

Object. The goal of this study was to delineate the angioanatomical features that determine whether a patient with an unruptured middle cerebral artery (MCA) aneurysm is treated using endovascular coil placement or surgical clipping.Methods. Thirty consecutive patients harboring 34 unruptured MCA aneurysms were evaluated. Patients with unruptured aneurysms are managed prospectively according to the following protocol: the primary treatment recommendation is endovascular packing with Guglielmi detachable coils (GDCs). Surgical clipping is recommended after failed attempts at coil placement or in the presence of angioanatomical features that contraindicate that type of endovascular therapy.Of 34 unruptured MCA aneurysms, two (6%) were successfully embolized and 32 (94%) were clipped. Of these 32 surgically treated aneurysms, in 11 (34%) an attempt at GDC embolization had failed, whereas in 21 (66%) primary clipping was performed because of unfavorable angioanatomy. Of the 13 aneurysms treated endovascularly, two (15%) were successfully excluded, whereas GDC treatment failed in 11 (85%). An unfavorable dome/neck ratio (< 2) and an arterial branch originating at the aneurysm base were the reasons for embolization failure.Conclusions. Careful evaluation of the angioanatomy of unruptured aneurysms allows selection of the most appropriate treatment. However, for unruptured MCA aneurysms, surgical clipping appears to be the most efficient treatment option. Series of unruptured aneurysms are ideal for comparing treatment results.

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