The Swedish Malignant Middle cerebral artery Infarction Study: long-term results from a prospective study of hemicraniectomy combined with standardized neurointensive care

OBJECTIVEA direct comparison of endovascular versus microsurgical treatment of ruptured middle cerebral artery (MCA) aneurysms in randomized trials is lacking. As endovascular treatment strategies continue to evolve, the number of reports of endovascular treatment of these lesions is increasing. Herein, the authors report a detailed post hoc analysis of ruptured MCA aneurysms treated by microsurgical clipping from the Barrow Ruptured Aneurysm Trial (BRAT).METHODSThe cases of patients enrolled in the BRAT who underwent microsurgical clipping for a ruptured MCA aneurysm were reviewed. Characteristics of patients and their clinical outcomes and long-term angiographic results were analyzed.RESULTSFifty patients underwent microsurgical clipping of a ruptured MCA aneurysm in the BRAT, including 21 who crossed over from the endovascular treatment arm. Four patients with nonsaccular (e.g., dissecting, fusiform, or blister) aneurysms were excluded, leaving 46 patients for analysis. Most (n = 32; 70%) patients presented with a Hunt and Hess grade II or III subarachnoid hemorrhage, with a high prevalence of intraparenchymal blood (n = 23; 50%), intraventricular blood (n = 21; 46%), or both. At the last follow-up (up to 6 years after treatment), clinical outcomes were good (modified Rankin Scale score 0–2) in 70% (n = 19) of 27 Hunt and Hess grades I–III patients and in 36% (n = 4) of 11 Hunt and Hess grade IV or V patients. There were no instances of rebleeding after the surgical clipping of aneurysms in this series at the time of last clinical follow-up.CONCLUSIONSMicrosurgical clipping of ruptured MCA aneurysms has several advantages over endovascular treatment, including durability over time. The authors report detailed outcome data of patients with ruptured MCA aneurysms who underwent microsurgical clipping as part of a prospective, randomized trial. These results should be used for comparison with future endovascular and surgical series to ensure that the best results are being achieved for patients with ruptured MCA aneurysms.

Download Full-text

Superficial Temporal Artery to Proximal Middle Cerebral Artery Anastomosis: Clinical and Angiographic Long Term Results

Neurosurgery ◽

10.1227/00006123-198612000-00015 ◽

1986 ◽

Vol 19 (6) ◽

pp. 992-997 ◽

Cited By ~ 15

Author(s):

Massimo Collice ◽

Orazio Arena ◽

Romero A. Fontana

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Good Alternative ◽

Neurological Complications ◽

Long Term Results ◽

Cortical Surface ◽

First Choice

Abstract Anastomosis of the superficial temporal artery (STA) with a proximal segment of the middle cerebral artery (MCA) has been proposed as a new cerebral revascularization technique alternative to the conventional bypass on the cortical surface. We introduced this procedure in our surgical practice in 1982 for patients with internal carotid artery (ICA) aneurysms not suitable for direct repair in whom occlusion of the ICA is considered necessary. One patient died because a conventional STA-MCA bypass did not prevent a major stroke caused by a therapeutic ICA occlusion. We are reporting our surgical technique and the immediate and long term clinical and angiographic results in five cases operated on during the period June 19, 1982, through January 19, 1983. The early and late patency rates were good. No neurological complications were observed after the bypass procedure or during a 3-year follow-up period. In our opinion, the use of proximal segments of the MCA as recipient arteries for supratentorial revascularization is a good alternative to the use of cortical surface arteries and, in selected cases, could be the first choice technique.

Download Full-text

818 Functional Outcome after Decompressive Hemicraniectomy for Massive Middle Cerebral Artery Infarction: Results of an Open Prospective Study

Neurosurgery ◽

10.1097/00006123-200108000-00182 ◽

2001 ◽

Vol 49 (2) ◽

pp. 541-541

Author(s):

Abbas Srour ◽

Bechir Jarraya ◽

Gerard Rancurel ◽

Jacques Philippon ◽

Philippe Cornu

Keyword(s):

Prospective Study ◽

Middle Cerebral Artery ◽

Functional Outcome ◽

Cerebral Artery ◽

Middle Cerebral Artery Infarction ◽

Decompressive Hemicraniectomy ◽

Open Prospective Study

Download Full-text

Allergic Fungal Rhinosinusitis Involving Frontal Sinus: A Prospective Study comparing Surgical Modalities

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1141 ◽

2013 ◽

Vol 6 (1) ◽

pp. 10-15

Author(s):

AK Gupta ◽

Rijuneeta LNU ◽

H Verma ◽

A Chakrabarti

Keyword(s):

Prospective Study ◽

Frontal Sinus ◽

Long Term Results ◽

Distinct Advantage ◽

Postoperative Results ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Group I ◽

A Prospective Study

ABSTRACT Allergic fungal rhinosinusitis (AFRS) represents a hypersensitivity response to extramucosal fungi within the sinus cavity without evidence of tissue invasion. AFRS is characterized by fungal element with allergic mucin, Charcot-Leyden crystals, type I hypersensitivity, bony erosion with sinus infection on computed tomographic (CT) scan. Surgery remains the treatment of choice for AFRS followed by prolonged steroid therapy. Surgical approaches for frontal sinus disease can be either endonasal endoscopic or external. This is a nonrandomized prospective study, where the postoperative results of endoscopic frontal sinusotomy were compared with external frontoethmoidectomy approach. This is a nonrandomized prospective study, where the postoperative results of endoscopic frontal sinusotomy were compared with external frontoethmoidectomy approach. The comparison between external frontoethmoidectomy and endoscopic approach was done by using Chi-square test. There was no statistical significant difference found, when postoperatively clinical symptoms, radiology and investigations in patients of both the groups were compared. The success rate was 95.5% in group I and 91.1% after 6 months of follow-up. The world literature lacks prospective studies where attempts are made to compare the long-term results of both the surgical modalities for AFRS patients. Endoscopic endonasal approach has a distinct advantage over the external frontoethmoidectomy approach as it minimizes external scars over the face with almost equal or better long-term results. How to cite this article Verma H, Rijuneeta, Gupta AK, Chakrabarti A. Allergic Fungal Rhinosinusitis Involving Frontal Sinus: A Prospective Study comparing Surgical Modalities. Clin Rhinol An Int J 2013;6(1):10-15.

Download Full-text