Image-Guided Surgery for Treatment of Unruptured 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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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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Minimally Invasive Transpalpebral ‘‘Eyelid’’ Approach to Unruptured Middle Cerebral Artery Aneurysms

Operative Neurosurgery ◽

10.1093/ons/opx021 ◽

2017 ◽

Vol 13 (4) ◽

pp. 453-464 ◽

Cited By ~ 8

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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Surgical management of middle cerebral artery aneurysms

Romanian Neurosurgery ◽

10.33962/roneuro-2019-004 ◽

2019 ◽

pp. 23-30

Author(s):

Mugurel Radoi ◽

Florin Stefanescu ◽

Ram Vakilnejad

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Cerebral Aneurysms ◽

Patient Characteristics ◽

Surgical Clipping ◽

Excellent Outcome ◽

Operative Control ◽

Mca Aneurysm ◽

Middle Cerebral Artery Aneurysms

Background. The middle cerebral artery (MCA) harbors approximately 14% to 30% of all ruptured cerebral aneurysms. They can occur at multiple sites throughout the course of the middle cerebral artery, but most often are found at the bifurcation of the first segment (M1). Methods. A retrospective review of 116 consecutive patients with an MCA aneurysm treated by surgical clipping, by two senior neurosurgeons, was performed. The data of all our consecutive patients were searched to obtain patient characteristics, details of the aneurysm size and orientation, treatment details, complications and follow up. At admission, the clinical condition of all patients was classified according to the Hunt and Hess scale. Clinical outcome was graded according to the modified Rankin scale. The follow-up period varied widely from 2 to 72 months (mean 30 months). Results. Surgical clipping was performed for 113 ruptured MCA aneurysms; only in 3 cases the aneurysm was unruptured. Fourteen patients presented with significant hematoma which required the evacuation of the clot. Post-operative control angiography was performed in 32 patients (27.5%), from which we reported a full occlusion of the aneurysm in 32 patients (93.75%). Perioperative mortality was 5.2% (6 patients), due to neurological (4 patients) or systemic causes (2 patients). The outcome was graded mRankin 0–2 in 72.5% of the cases (84 patients) at the end of the first postoperative months, and 78.5% (91 patients) at six months follow-up. The most important improvement was recorded for patients graded mRankin 1-2 at the first month follow-up. All 3 patients with a surgically treated asymptomatic MCA aneurysm had an excellent outcome (mRS 0) at both follow-up, 1 months and respectively 6 months. Conclusions. For the experienced neurovascular team, MCA aneurysms currently make microsurgical treatment the preferred treatment modality for most MCA aneurysms.

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Endovascular and Surgical Options for Ruptured Middle Cerebral Artery Aneurysms: Review of the Literature

Stroke Research and Treatment ◽

10.1155/2014/315906 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

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.

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Endovascular coiling of middle cerebral artery aneurysms as an alternative to surgical clipping

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2012.02.054 ◽

2013 ◽

Vol 20 (4) ◽

pp. 520-522 ◽

Cited By ~ 16

Author(s):

Kyung-Hwan Kim ◽

Ki-Chul Cha ◽

Jong-Soo Kim ◽

Seung-Chyul Hong

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Endovascular Coiling ◽

Surgical Clipping ◽

Middle Cerebral Artery Aneurysms

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Image Guidance for Transcranial Doppler Ultrasonography

Operative Neurosurgery ◽

10.1227/neu.0b013e31821553b2 ◽

2011 ◽

Vol 68 (suppl_2) ◽

pp. ons257-ons266 ◽

Cited By ~ 3

Author(s):

Sven R. Kantelhardt ◽

Christian Greke ◽

Naureen Keric ◽

Fritz Vollmer ◽

Ingmar Thiemann ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Transcranial Doppler ◽

Image Guidance ◽

Flow Analysis ◽

Vascular Anatomy ◽

Diagnostic Procedures ◽

Computed Tomographic Angiography ◽

Guidance System ◽

Image Guided

Abstract Background: Transcranial Doppler (TCD) ultrasonography is an important tool for noninvasive detection and monitoring of vasospasm and other pathological conditions of the intracranial vessels. Objective: To demonstrate that image-guided TCD allows rapid identification and blood-flow analysis of specific sections of the vascular anatomy and provides excellent orientation, also allowing diagnostic procedures on pathological vascular structures. Methods: Three patients who underwent computed tomographic angiography scanning for reasons not related to this study were examined by neuronavigated image-guided TCD. The Doppler probe was fitted with reflective markers and tracked by a commercially available Kolibri image guidance system. Results: Image-guided TCD allowed identification of all major intracranial vessels. Unilateral acquisition of reliable Doppler signals for the internal carotid artery, carotid T, middle cerebral artery, middle cerebral artery bifurcation, and anterior cerebral artery required 14 ± 6 minutes. Preregistration of these targets and detection by neuronavigation alone shortened examination times significantly to 8 ± 2 minutes. Registering the optimal examination trajectories on the neuronavigational device and applying navigational pilot software shortened times for repetitive examination further to 4 ± 1 minutes and ensured that the examination was done at the exact same spot under the same angle as in previous examinations. Conclusion: Image guidance can be applied easily and efficiently to TCD. It provides anatomic orientation and may help to standardize investigation protocols, define pathological vascular territories for repeat investigations, and thus reduce interinvestigator variations. Image guidance may also extend the use of TCD to situations of a pathological or variant vascular anatomy.

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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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