Microsurgical Removal of Arteriovenous Malformations of the Basal Ganglia

Neurosurgery ◽  
1988 ◽  
Vol 23 (2) ◽  
pp. 209-217 ◽  
Author(s):  
Ghaus M. Malik ◽  
Felix Umansky ◽  
Suresh Patel ◽  
James I. Ausman
Keyword(s):  
Basal Ganglia ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Arteriovenous Malformations ◽  
The Other ◽  
Microsurgical Treatment

ABSTRACT Arteriovenous malformations in the basal ganglia region have been a problem in neurosurgical practice. We report six cases of deep-seated malformations fed mainly by the perforating branches of the middle cerebral artery. There were no deaths in the series. Four patients returned to their previous activities, and the other two patients had persistent hemiparesis and dysphasia, present preoperatively, with worsening in one case. Both of these patients improved and are independent. We show the feasibility of satisfactory microsurgical treatment of these lesions based on the knowledge of microanatomical studies.

scholarly journals ANATOMÍA MACROSCÓPICA E IMAGENOLÓGICA DE LAS RAMAS PRECOCES DE LA ARTERIA CEREBRAL MEDIA. Macroscopic and radiological anatomy of early branches of the middle cerebral artery

2016 ◽  
Vol 5 (3) ◽  
pp. 194-201
Author(s):  
Fernando Martínez ◽  
Gabriela Castro ◽  
Rodrigo Moragues ◽  
Edgardo Spagnuolo ◽  
Gonzalo Estapé
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
The Other ◽  
Cerebral Hemispheres ◽  
Radiological Anatomy ◽  
Angiographic Data ◽  
Formalin Fixed

Las ramas precoces de la arteria cerebral media son ramas corticales originadas del tronco de la citada arteria. Se trata de arterias que pueden nutrir importantes áreas de los lóbulos temporal, frontal o la ínsula. Por lo tanto, la oclusión de una de estas ramas producirá un área de isquemia con potenciales consecuencias. Se estudiaron 20 hemisferios cerebrales  de cadáveres adultos conservados en formol, y 20 angiografías silvianas realizando una comparación y correlación. En las piezas anatómicas, la arteria cerebral media terminó por bifurcación en el 100% de los casos y dicha bifurcación se sitúo en la porción esfenoidal (M1) en la mayoría de las piezas. Se encontraron ramas precoces en número de1 a4 en el 80%, totalizando 28 arterias, de las cuales 23 tenían destino temporal y 5 frontales. En el material angiográfico la cerebral media terminó por bifurcación en el 95% de los casos y la misma se ubicó en M1 en la mayoría de los casos. Se encontraron ramas precoces en el 70% de los estudios analizados, totalizando 19 ramos. De los mismos, 16 fueron temporales, 1 frontal y en 2 casos no se pudo determinar su destino. Consideramos que los datos anatómicos y angiográficos obtenidos por este y otros estudios son de utilidad en la planificación del clipado de  los aneurismas de la cerebral media. The early branches of the middle cerebral artery are cortical branches that arise from the trunk of this artery. These branches can supply significant areas in the temporal, frontal or insular lobes. Therefore, their occlusion may lead to ischemia and potential sequelae. We studied 20 cerebral hemispheres of formalin-fixed adult cadavers and 20 silvian angiographies in order to compare and correlate them. In the anatomical specimens, the middle cerebral artery ended bifurcating in 100% of the cases and such bifurcation occurred at the sphenoidal segment (M1) in most cases. Early branches ranging from 1 to 4 were found in 80% of the cases, totalizing 28 arteries, out of which 23 had a temporal destination and5 afrontal one. In the angiographic material, the middle cerebral artery ended in a bifurcation pattern in 95% of the cases. This bifurcation occurred mostly at M1 as well. Early branches were found in 70% of the cases, which totalized 19 branches. Sixteen of them were temporal branches, 1 was frontal and the other 2 could not be determined. We consider that the anatomical and angiographic data obtained at this and other studies are useful when it comes to planify the clipping of silvian aneurysms.

scholarly journals A Double Catheter Technique for Elongated Middle Cerebral Artery Bifurcation Aneurysm

2006 ◽  
Vol 12 (1) ◽  
pp. 41-44 ◽  
Author(s):  
S.C. Kwon ◽  
Y.S. Shin ◽  
H.S. Kim ◽  
S.Y. Kim
Keyword(s):  
Middle Cerebral Artery ◽  
Effective Treatment ◽  
Cerebral Artery ◽  
The Other ◽  
Parent Artery ◽  
Catheter Technique ◽  
Bifurcation Aneurysm

We report a case of an elongated middle cerebral artery bifurcation aneurysm which was managed using an endovascular double catheter technique. After positioning two microcatheters, one at the distal dome and the other at the proximal dome, two coils were subsequently deployed through each microcatheter. We created a proximal supporting coil frame using one microcatheter and preserved the parent artery, and then deposited subsequent packing coils at the distal aneurysm sac region using the other microcatheter. The proximal framing coils did not detach prior to obtaining satisfactory aneurysm packing through the distally positioned microcatheter. This approach allowed for the proximal coil to be withdrawn if there was any evidence of the proximal coil frame changing shape or of parent artery protrusion. This double microcatheter technique provided safe and effective treatment of an elongated middle cerebral artery bifurcation aneurysm.

scholarly journals Middle cerebral artery fenestration: Thromboembolic and hemorrhagic complications

2019 ◽  
Vol 25 (6) ◽  
pp. 644-647
Author(s):  
Mohamad Abdalkader ◽  
Christian Raftopoulos ◽  
Patrice Finet ◽  
Thanh N Nguyen ◽  
Pierre Goffette
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Arteriovenous Malformations ◽  
Cross Sectional ◽  
Vascular Abnormalities ◽  
Artery Thrombosis ◽  
Hemorrhagic Complications ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Cerebral artery fenestrations are rare anatomical variants usually detected incidentally on cross-sectional imaging or cerebral angiography. Although considered benign findings, many reports have described their association with vascular abnormalities such as aneurysms or arteriovenous malformations, and to a lesser extent with ischemic or hemorrhagic complications. We report a case of middle cerebral artery fenestration associated with subarachnoid hemorrhage and middle cerebral artery thrombosis. To our knowledge, there has been no prior report of middle cerebral artery fenestration with a similar presentation.

scholarly journals Angiographic Morphological Characteristics of Middle Cerebral Artery aneurysms

2018 ◽  
Vol 24 (3) ◽  
pp. 208-211
Author(s):  
Antônio Santos de Araújo Junior ◽  
Paulo Henrique Pires De Aguiar ◽  
Daniel De Carvalho Kirchhoff ◽  
Apio Cláudio Antunes ◽  
Marco Antonio Stefani ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Morphological Characteristics ◽  
Aneurysm Rupture ◽  
The Other ◽  
Single Institution ◽  
Unruptured Aneurysms ◽  
Middle Cerebral Artery Aneurysms ◽  
Vascular Neurosurgery ◽  
Time Of Admission

Background: The treatment of Middle Cerebral Artery Aneurysms (MCAA) and the relation of their morphology to the chance of  rupture are an important topic in vascular neurosurgery. Objective: To assess the correlation between MCAA morphology and 1) the chance of aneurysm rupture and 2) its morbimortality. Methods: Twenty-nine patients with MCAA at the M1 segment (4 patients had multiple aneurysms), were followed/ treated by our crew at a single institution over the last 5 years; 14 aneurysms were ruptured at the time of admission and 15 were diagnosed incidentally. Aneurysms were classified by shape and their geometries were correlated with rupture rate and their morbimortality. Results: Aneurysms measured between 7 and 10 mm in diameter (90% of the aneurysms), and there was no difference in size between the ruptured and unruptured aneurysms. Patients whose MCAAs were ruptured at admission were 3 times as likely than patients with unruptured aneurysms to have a transverse elliptic or inverted-pear-shaped aneurysm (21% vs 9%, p<0.05). On the other hand, patients with unruptured MCAAs were 6 times more likely than patients with ruptured MCAAs to have a pear-shaped aneurysm (36.3% vs 5.2%, p<0.001). Round-shaped aneurysms were more frequent overall, but they were not significantly more prone to rupture. Conclusion: Although this was a small group of patients, we conclude that transverse elliptic and inverted-pear-shaped aneurysms were more associated with rupture than round/ pear-shaped aneurysms.

Clip-first policy versus coil-first policy for the exclusion of middle cerebral artery aneurysms

2020 ◽  
Vol 133 (4) ◽  
pp. 1124-1131 ◽  
Author(s):  
David Hassanein Berro ◽  
Vincent L’Allinec ◽  
Anne Pasco-Papon ◽  
Evelyne Emery ◽  
Mada Berro ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Functional Outcome ◽  
Selection Bias ◽  
Cerebral Artery ◽  
Complication Rate ◽  
The Other ◽  
Temporal Muscle ◽  
Treatment Groups ◽  
Risk Of Death

OBJECTIVEMiddle cerebral artery (MCA) aneurysms are a particular subset of intracranial aneurysms that can be excluded by clipping or coiling. A comparison of the results between these two methods is often limited by a selection bias in which wide-neck and large aneurysms are frequently treated with surgery. Here, the authors report the results of two centers using opposing policies in the management of MCA aneurysms: one center used a clip-first policy while the other used a coil-first policy, which limited the selection bias and ensured a good comparison of these two treatment modalities.METHODSAll patients treated for either ruptured or unruptured MCA aneurysms at one of two institutions between January 2012 and December 2015 were eligible for inclusion in this study. At one center a clip-first policy was applied, whereas the other applied a coil-first policy. The authors retrospectively reviewed the medical records of these patients and compared their clinical and radiological outcomes.RESULTSA total of 187 aneurysms were treated during the inclusion period; 88 aneurysms were treated by coiling and 99 aneurysms by clipping. The baseline patient and radiological characteristics were similar between the two groups, but the clinical presentation of the ruptured aneurysm cohort differed slightly. In the ruptured cohort (n = 90), although patients in the coiling group had a higher rate of additional surgery, the complication rate, functional outcome, and risk of death were similar between the two treatment groups. In the unruptured cohort (n = 97), the complication rate, functional outcome, and risk of death were also similar between the two treatment groups, although the risk of discomfort related to the temporal muscle atrophy was higher in the surgical group. Overall, the rate of complete occlusion was higher in the clipping group (84.2%) than in the coiling group (31%), which led to a higher risk in the coiling group of aneurysm retreatment within the first 2 years (p = 0.04).CONCLUSIONSClipping and coiling for MCA aneurysm treatment provide the same clinical outcome for ruptured and unruptured aneurysms. However, clipping provides higher short- and long-term rates of complete exclusion, which in turn decreases the risk of aneurysm retreatment. Whether this lower occlusion rate can have a clinical impact in the long-term must be further evaluated.

Microsurgical Clipping and Bypass for Fusiform Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Nickalus R Khan ◽  
Stephanie H Chen ◽  
Jacques J Morcos
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Superficial Temporal Artery ◽  
Artery Aneurysm ◽  
Patient Discharge ◽  
Temporal Artery ◽  
Surgical Anatomy ◽  
Microsurgical Treatment ◽  
Microsurgical Clipping

Abstract Fusiform middle cerebral artery (MCA) aneurysms that require treatment can often necessitate complex endovascular or microsurgical treatment. We present a case of a 25-yr-old female with an incidentally discovered left 14-mm fusiform MCA aneurysm incorporating the frontal MCA trunk origin in its dome. The location and anatomy were not favorable for endovascular treatment with flow diversion.  The patient was offered continued observation or microsurgical treatment. Direct clipping of this aneurysm was not possible. After a thorough discussion of the risks, benefits, indications, and natural history of the lesion, the patient desired to have the aneurysm treated given her young age, location, size of the aneurysm, and the significant clinical experience of the treating team in bypass surgery.  The patient underwent superficial temporal artery to frontal M2 (STA-FM2) direct bypass for flow replacement followed by microsurgical trapping and clip ligation. The patient was maintained on antiplatelet therapy preoperatively and postoperatively. The patient had a transient aphasia and mild right upper extremity weakness (4/5) in the immediate postoperative period, which fully recovered by the time of patient discharge. The case presentation, surgical anatomy, technique, and postoperative course and outcome are reviewed. The different strategies for bypass and clip ligation are reviewed with particular focus on the anatomic constraints for each bypass configuration. The outcomes of bypass surgery for MCA aneurysms are reviewed.1-7 The patient gave verbal consent for participating in the procedure, surgical video, and publication of their image.

Intraoperative monitoring of blood flow insufficiency during surgery of middle cerebral artery aneurysms

2005 ◽  
Vol 103 (2) ◽  
pp. 275-283 ◽  
Author(s):  
Kazuomi Horiuchi ◽  
Kyouichi Suzuki ◽  
Tatsuya Sasaki ◽  
Masato Matsumoto ◽  
Jun Sakuma ◽  
...  
Keyword(s):  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Evoked Potential ◽  
Control Level ◽  
The Other ◽  
Somatosensory Evoked Potential ◽  
Content Type ◽  
Sep Monitoring ◽  
Fine Print

Object. The usefulness of motor evoked potential (MEP) monitoring to detect blood flow insufficiency (BFI) in the cortical branches of the middle cerebral artery (MCA) and lenticulostriate arteries (LSAs) during MCA aneurysm surgery was investigated based on the correlation between MEP and somatosensory evoked potential (SEP) monitoring. Methods. Fifty-three patients with MCA aneurysms underwent surgery accompanied by intraoperative MEP and SEP monitoring. There was no postoperative motor paresis in 43 patients in whom MEP and SEP results remained unchanged. In the other 10 patients, nine manifested transient MEP changes; in five of these, SEP changes did not occur. The transient MEP changes were thought to be attributable to BFI of the MCA cortical branches in two patients, the LSA in three, and either the MCA branches or the LSA in four patients. Of these nine patients, six did not present with postoperative motor paresis; transient motor paresis was recognized in the other three. In the 10th patient, MEP waves disappeared and did not recover. This patient's SEPs remained at 70% of the control level, and he developed severe hemiparesis. A postoperative computerized tomography scan revealed a new low-density area in the corona radiata and putamen. Conclusions. Blood flow insufficiency in both the LSA and MCA cortical branches that perfuse the corticospinal tract can be detected by intraoperative MEP monitoring. Somatosensory evoked potential monitoring is not reliable enough to detect BFI in the MCA branches and the LSAs.

scholarly journals Sufficient collateral blood supply from accessory middle cerebral artery in a patient with acute ischemic stroke

2015 ◽  
Vol 21 (2) ◽  
pp. 215-217 ◽  
Author(s):  
Zhen-Sheng Liu ◽  
Long-Jiang Zhou ◽  
Yong Sun ◽  
Xiong-Wei Kuang ◽  
Wei Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Basal Ganglia ◽  
Middle Cerebral Artery ◽  
Blood Supply ◽  
Cerebral Artery ◽  
Transient Ischemic Attack ◽  
Modified Rankin Scale ◽  
Nihss Score ◽  
Accessory Middle Cerebral Artery ◽  
Ischemic Attack

We reported a case of acute embolic occlusion of the middle cerebral artery with a patent accessory middle cerebral artery. Because of the presence of sufficient collateral blood supply from the accessory middle cerebral artery, the patient only underwent transient ischemic attack and did not need endovascular treatment. There was mild infarction in the basal ganglia and temporal lobe, NIHSS score of the patient at discharge seven days after stroke onset was 0, and modified Rankin scale score at 90 days was 0.

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