scholarly journals Endovascular Treatment of Middle Cerebral Artery Aneurysms

2008 ◽  
Vol 14 (3) ◽  
pp. 241-245 ◽  
Author(s):  
G. Guglielmi ◽  
F. Viñuela ◽  
G. Duckwiler ◽  
R. Jahan ◽  
E. Cotroneo ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Mortality Rates ◽  
Morbidity Rate ◽  
Aneurysm Neck ◽  
Clinical Consequences ◽  
Endovascular Approach ◽  
Permanent Morbidity ◽  
Middle Cerebral Artery Aneurysms

The endovascular approach is described in 113 middle cerebral artery (MCA) aneurysms. The treatment failed in six cases with no adverse clinical consequences. Out of the 107 treated cases, it was possible to obtain a complete occlusion in 50 aneurysms (47%), whereas a residual aneurysm neck was observed in 54 cases (50%). Follow-up angiograms were performed in 60 cases, showing a 22% rate of further thrombosis of the aneurysm. Recanalization of the aneurysm was observed in 8% of cases, which required retreatment. The technique-related permanent morbidity rate was 9% while the mortality rate was 2%. A review of the surgical and endovascular literature is presented. The endovascular approach is particularly indicated when normal MCA branches do not arise from the aneurysm base. It must be meticulously planned in all other cases. Endovascular coil treatment of MCA aneurysms is feasible, with acceptable morbi-mortality rates.

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.

Surgical treatment of middle cerebral artery aneurysms

1984 ◽  
Vol 61 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Jiro Suzuki ◽  
Takashi Yoshimoto ◽  
Takamasa Kayama
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Surrounding Tissue ◽  
Surgical Results ◽  
Content Type ◽  
Aneurysm Neck ◽  
Social Lives ◽  
Middle Cerebral Artery Aneurysms ◽  
Fine Print

✓ The authors report their experience with the surgical therapy of middle cerebral artery (MCA) aneurysms in 413 cases, and describe their technique. After the M1 portion of the MCA is identified, the Sylvian fissure is opened. During the administration of 20% mannitol, temporary occluding clips are applied to the feeding and draining vessels of the aneurysm. The aneurysm is freed from all surrounding tissue, and the aneurysm neck is treated by ligation, clipping, or wrapping. Analysis of surgical results in 91 cases operated on after the surgical approach had become standardized indicates that more than 94% of patients have returned to useful social lives by the time of follow-up evaluation. Twenty-four percent of these patients were operated on within 48 hours after subarachnoid hemorrhage.

One-year Angiographic Results After pCONus Stent-Assisted Coiling of 40 Wide-Neck Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2017 ◽  
Vol 80 (6) ◽  
pp. 925-933 ◽  
Author(s):  
Benjamin Gory ◽  
Marta Aguilar-Pérez ◽  
Elisa Pomero ◽  
Francis Turjman ◽  
Werner Weber ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Coiling ◽  
Total Occlusion ◽  
Complete Occlusion ◽  
Neck Size ◽  
Clinical Complications ◽  
Middle Cerebral Artery Aneurysms ◽  
Wide Neck

Abstract BACKGROUND: Bifurcation middle cerebral artery (MCA) aneurysms with wide neck are amenable to endovascular coiling with pCONus stent, a recent device dedicated to wide-neck bifurcation intracranial aneurysms. OBJECTIVE: To evaluate the 1-year angiographic follow-up of wide-neck MCA aneurysms treated with pCONus. METHODS: Forty MCA aneurysms (mean dome size, 7.7 mm; mean neck size, 5.6 mm) coiled with pCONus were retrospectively evaluated. “Recanalization” was defined as worsening, and “progressive thrombosis” was defined as improvement on the Raymond scale. RESULTS: Angiographic midterm (mean, 11.9 months; range, 3-20) follow-up was obtained in all aneurysms. Retreatment was performed in 9 aneurysms (22.5%) without clinical complications, and postoperative angiographic outcome included 2 complete occlusions and 7 neck remnants. Six aneurysms were followed after retreatment (mean, 8.8 months), and presented complete occlusion in 1 case, neck remnant in 4 cases, and aneurysm remnant in 1 case. Among the 31 aneurysms, follow-up showed complete occlusion in 67.7% (21/31), neck remnants in 29% (9/31), and aneurysm remnants in 3.3% (1/31). Adequate aneurysm occlusion (total occlusion and neck remnant) was obtained in 96.7% (30/31). Among these 31 aneurysms, improvement of the rate of occlusion was observed in 15 aneurysms (48.4%), and recurrence in 2 aneurysms (6.5%). There was no 1-year angiographic recurrence of 3- or 6-month totally occluded aneurysms. CONCLUSION: pCONus stent allows a safe coiling of wide-neck MCA aneurysms usually considered as surgical with a low recanalization rate for those adequately occluded at 3 to 6 months. Angiographic results improve over time due to progressive aneurysm thrombosis in around 50% of cases.

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.

Outcome for Middle Cerebral Artery Aneurysm Surgery

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 755-761 ◽  
Author(s):  
Michael K. Morgan ◽  
Wattana Mahattanakul ◽  
Andrew Davidson ◽  
John Reid
Keyword(s):  
Risk Factors ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Surgical Outcome ◽  
Artery Aneurysm ◽  
Morbidity Rate ◽  
Mortality And Morbidity ◽  
Logistic Analysis ◽  
Middle Cerebral Artery Aneurysms ◽  
Cerebral Artery Aneurysm

Abstract OBJECTIVE To assess in depth the variables contributing to adverse surgical outcome for repair of unruptured middle cerebral artery aneurysms. METHODS Prospectively collected data between October 1989 and June 2009 were examined retrospectively. Putative risk factors were investigated with univariate and multivariate logistic regression analyses. RESULTS In this study, 263 patients (339 aneurysms) underwent surgical clipping in 280 operations for unruptured middle cerebral artery aneurysms. The overall surgical mortality and morbidity rate was 5% (95% confidence interval [CI], 2.9–8.3). Multivariate logistic analysis of risk factors revealed that age and aneurysm size were independent predictors of surgical outcome. Patients < 60 years of age with an aneurysm ≤ 12 mm constituted a low-risk group with a procedure-related combined mortality and morbidity of 0.6% (95% CI, 0–3.8). Patients < 60 years of age with an aneurysm > 12 mm had a procedure-related combined mortality and morbidity of 7.4% (95% CI, 1–24.5). Patients ≥ 60 years of age with an aneurysm of ≤ 12 mm had a procedure-related combined mortality and morbidity of 9.3% (95% CI, 4.3–18.3). Patients ≥ 60 years of age with an aneurysm > 12 mm had a procedure-related combined mortality and morbidity of 22.2% (95% CI, 8.5–45.8). CONCLUSION Age and size of aneurysm were the only 2 independent predictors of surgical outcome.

scholarly journals Remote results of endovascular treatment of middle cerebral artery aneurysms

2015 ◽  
Vol 17 (2) ◽  
pp. 28
Author(s):  
D. V. Shcheglov
Keyword(s):  
Postoperative Complications ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Considerable Increase ◽  
Mass Effect ◽  
Endovascular Occlusion ◽  
Middle Cerebral Artery Aneurysms

Our objective was to study the dynamics of remote results of MCA SA endovascular occlusion. 149 patients with MCA SA were examined and operated, 127 patients were selected for 36 months follow-up, 112 patients in 1 year follow-up, 52 patients were to be examined in 23 years, 17 in 45 years and 14 patients in more than 5 years. Endovascular occlusion was carried out by means of different coils during reconstructive 138 (92.6%) and unplanned deconstructive occlusions 8 (5.4%). For planned deconstructions detachable balloons were used 3 (2%). 17 (11.4%) recurrences were diagnosed and 12 (8%) repeated operations were performed. 19 (12.8%) intra-and postoperative complications/ predictors and 18 (12.1%) complications unrelated to surgery were observed in the first 30 days and only 1 (1.1%) mass effect was identified in 36 months. After our research we were ableto trackthe dynamicsof thepatientslife quality according totheRankinscale; tomonitorthe changes in SA occlusion degree; to define the frequency of recurrences and complications/predictors of complications and to determine the amount of reoperations. We noted a considerable increase in the quantity of total occlusions after reoperations, which resulted in much better filling of the CA cavity, because the prophylaxis of the repeated hemorrhages is the main goal of SA endovascular treatment.

scholarly journals Microsurgical treatment of unruptured middle cerebral artery aneurysms: a large, contemporary experience

2019 ◽  
Vol 130 (5) ◽  
pp. 1498-1504 ◽  
Author(s):  
Eric S. Nussbaum ◽  
Michael T. Madison ◽  
James K. Goddard ◽  
Jeffrey P. Lassig ◽  
Kevin M. Kallmes ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Morbidity Rate ◽  
Parent Artery ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Indocyanine Green Videoangiography ◽  
Parent Artery Occlusion ◽  
Aneurysm Occlusion

OBJECTIVEAdvances in endovascular therapy for the treatment of middle cerebral artery (MCA) aneurysms have led to scrutiny of its benefits compared with microsurgical repair. To provide information regarding complication rates and outcomes, the authors reviewed the results of a large series of unruptured MCA aneurysms treated with open microsurgery.METHODSThe authors included all patients who underwent surgical repair of an unruptured MCA aneurysm between 1997 and 2015. All surgical procedures, including clipping, wrapping, bypass, and parent artery occlusion, were performed by a single neurosurgeon. Aneurysm occlusion was assessed using intraoperative digital subtraction angiography (DSA) or DSA and indocyanine green videoangiography in all cases. Postoperatively, all patients were monitored in a neurointensive care unit overnight. Clinical follow-up was scheduled for 2–4 weeks after surgery, and angiographic follow-up was performed in those patients with subtotally occluded aneurysms at 1, 2, and 5 years postoperation.RESULTSThe authors treated 750 unruptured MCA aneurysms in 716 patients: 649 (86.5%) aneurysms were small, 75 (10.0%) were large, and 26 (3.5%) were giant. Most aneurysms (n = 677, 90%) were treated by primary clip reconstruction. The surgical morbidity rate was 2.8%, and the mortality rate was 0%. Complete angiographic aneurysm occlusion was achieved in 92.0% of aneurysms. At final follow-up, 713 patients had a modified Rankin Scale (mRS) score of 0, 2 patients had an mRS score of 2 or 3, and 1 had an mRS score of 4.CONCLUSIONSIn high-volume centers, microsurgical management of MCA aneurysms can be performed with very low morbidity rates. Currently, microsurgical repair appears to be a highly effective method of treating MCA aneurysms.

Endovascular Treatment of 174 Middle Cerebral Artery Aneurysms: Clinical Outcome and Radiologic Results at Long-term Follow-up

Radiology ◽  
2009 ◽  
Vol 253 (1) ◽  
pp. 191-198 ◽  
Author(s):  
Jean-François Vendrell ◽  
Nicolas Menjot ◽  
Vincent Costalat ◽  
Denis Hoa ◽  
Jorge Moritz ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Long Term Follow Up ◽  
Middle Cerebral Artery Aneurysms
Sign in / Sign up

Export Citation Format

Share Document