Usefulness of Preoperative Three-Dimensional Computed Tomographic Angiography With Two-Dimensional Computed Tomographic Imaging for Rupture Point Detection of Middle Cerebral Artery Aneurysms

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS126-ONS133 ◽  
Author(s):  
Kojiro Wada ◽  
Hirohiko Arimoto ◽  
Hidenori Ohkawa ◽  
Toshiki Shirotani ◽  
Yohsitaro Matsushita ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Ct Angiography ◽  
Cerebral Artery ◽  
Three Dimensional ◽  
Ct Image ◽  
Two Dimensional ◽  
Computed Tomographic ◽  
Transsylvian Approach ◽  
Risk Of Rupture ◽  
Middle Cerebral Artery Aneurysms

Abstract Objective: We report the technique of three-dimensional computed tomographic (CT) angiography with a two-dimensional CT image aiding in the early operation of ruptured middle cerebral artery aneurysms. This combined image allows the prediction of the rupture point in the aneurysm and may reduce the risk of rupture during early clipping surgery. Methods: The findings for 14 patients with 14 middle cerebral artery ruptured aneurysms who underwent subsequent early clipping were analyzed. The average aneurysm size was 8.5 mm, and there were two large and one giant aneurysms. CT examinations were performed by means of a multidetector CT scanner (Aquilion M16; Toshiba Medical Systems, Tokyo, Japan) and reconstructed with a workstation (ZIO M900 QUADRA; Amin Co., Ltd., Tokyo, Japan). We constructed an operating view through three-dimensional CT angiography for a lateral transsylvian approach with a two-dimensional CT image (nonshaded volume-rendering image), which was perpendicular to the direction of the surgical approach. Using this combined image, we predicted the rupture point of the aneurysm and successfully performed clipping surgery through a lateral transsylvian approach. Rupture points were confirmed at the time of surgery. Rupture points of 13 out of 14 aneurysms appeared as we expected, but one differed; all aneurysms were successfully clipped. Thirteen of the 14 patients could be clipped without rupture at surgery, but the remaining patient experienced rupture just after craniotomy. Conclusion: The combination of three-dimensional CT angiography and two-dimensional CT images may help improve the surgical outcome by indicating aneurysmal rupture points, leading to the prevention of rupture.

scholarly journals Middle cerebral artery aneurysms: aneurysm angiographic morphology and its relation to pre-operative and intra-operative rupture

2017 ◽  
Vol 75 (8) ◽  
pp. 523-532 ◽  
Author(s):  
Iracema Araújo Estevão ◽  
Bruno Camporeze ◽  
Antonio Santos de Araujo Jr ◽  
Breno Nery ◽  
Ápio Claudio Martins Antunes ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Operative Risk ◽  
Fisher Test ◽  
Rupture Rate ◽  
Bifurcation Aneurysm ◽  
Risk Of Rupture ◽  
Aneurysm Morphology ◽  
Significant Disability ◽  
Middle Cerebral Artery Aneurysms

ABSTRACT Objective Correlate the middle cerebral artery bifurcation aneurysm morphology with the pre-operative and intra-operative risk of rupture. Methods Forty patients with 46 middle cerebral artery bifurcation aneurysms were treated microsurgically by the same surgeon. Aneurysms were classified according to shape and the Fisher test was applied to analyze the effect of morphology on the pre-operative and intra-operative rupture. Results Pre-operative and intra-operative ruptures were observed in 8/46 patients (17.4%) and 14/46 patients (30.4%) respectively. Thirty-two cases (69.6%) had no symptoms postoperatively, modified Rankin score (MRS) of 0; 6.5% had MRS of 1 (no significant disability); 13% had MRS of 2 (slight disability); 4.3% had moderately severe disability (MRS of 4); and there were 3 deaths (6.5%) post-operatively. The morphology was not directly related to the rupture rate. Conclusion In general, ruptures are not affected by the morphology or the studied variables. Larger series are needed to validate these outcomes.

Three-dimensional helical computerized tomography angiography in the diagnosis, characterization, and management of middle cerebral artery aneurysms: comparison with conventional angiography and intraoperative findings

2002 ◽  
Vol 97 (6) ◽  
pp. 1322-1332 ◽  
Author(s):  
J. Pablo Villablanca ◽  
Parizad Hooshi ◽  
Neil Martin ◽  
Reza Jahan ◽  
Gary Duckwiler ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Treatment Planning ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Cerebral Artery ◽  
Three Dimensional ◽  
Content Type ◽  
Computerized Tomography Angiography ◽  
Fine Print

Object. Middle cerebral artery (MCA) aneurysms can be difficult to detect and characterize. The authors describe the utility and impact of helical computerized tomography (CT) angiography for the evaluation of aneurysms in this location, and compare this modality with digital subtraction (DS) angiography and intraoperative findings. Methods. Two hundred fifty-one patients with suspected cerebral aneurysms underwent CT angiography. Two-dimensional multiplanar reformatted images and three-dimensional CT angiograms were examined by two independent readers in a blinded fashion. Results were compared with findings on DS angiograms to determine the relative efficacy of these modalities in the detection and characterization of aneurysms. Questionnaires completed by neurosurgeons and endovascular therapists were used to determine the impact of CT angiograms on aneurysm management. Twenty-eight patients harboring 31 MCA aneurysms and 26 patients without aneurysms were identified using CT angiography. The sensitivity of CT angiography and DS angiography for MCA aneurysms was 97%; both techniques showed 100% specificity. In 76% of evaluations, the CT angiography studies provided information not available on DS angiography examinations. For the characterization of aneurysms, CT angiography was rated superior (72%) or equal (20%) to DS angiography in 92% of cases evaluated (p < 0.001). Computerized tomography angiography was evaluated as the only study needed for patient triage in 82% of cases (p < 0.001), and as the only study needed for treatment planning in 89% of surgically treated (p < 0.001) and in 63% of endovascularly treated cases (p < 0.001). The information acquired on CT angiograms changed the initial treatment plan in 24 (67%) of these 36 complex lesions (p < 0.01). The aneurysm appearance intraoperatively was identical or nearly identical to that seen on CT angiograms in 17 (89%) of 19 of the surgically treated cases. Conclusions. Computerized tomography angiography has unique advantages over DS angiography and is a viable alternative to the latter modality in the diagnosis, triage, and treatment planning in patients with MCA aneurysms.

scholarly journals Morphology of Middle Cerebral Artery Aneurysms: Impact on Surgical Strategy and on Postoperative Outcome

ISRN Stroke ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Karl-Michael Schebesch ◽  
Martin Proescholdt ◽  
Kathrin Steib ◽  
Odo-Winfried Ullrich ◽  
Andreas Herbst ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Morphological Characteristics ◽  
Postoperative Outcome ◽  
Irregular Shape ◽  
Maximum Diameter ◽  
Parent Artery ◽  
Risk Of Rupture ◽  
Middle Cerebral Artery Aneurysms ◽  
Intraoperative Rupture

The outcome of middle cerebral artery (MCA) aneurysm clipping depends on the presence of subarachnoid hemorrhage (SAH). Moreover, it is influenced by anatomical features of the aneurysm and its parent artery. We hypothesized that morphological characteristics of the aneurysm may be predictive for postoperative outcome. Therefore, we identified radiographic assessable details that predicted the surgical difficulty and the risk for new ischemia. The angiograms of 151 consecutive patients (82 presenting with SAH) were analyzed in a standardized fashion focusing on 12 defined morphological aspects. The results were correlated to intraoperative rupture and to postoperative ischemia. Aneurysms presenting with SAH were associated with irregular shape, larger maximum diameter, and larger dome-to-base distance (DBD) and were located more frequently on the M2 segment. Multivariate analysis revealed 6 independent predictors for intraoperative rupture: SAH, location on M2 segment, DBD, maximum diameter, diameter of the parent MCA, and the presence of branching vessel. Independent predictors of surgery-related ischemia were identified: SAH, irregular shape, location on M2 segment, DBD, and the neck-to-vessel ratio (NVR). In MCA aneurysms, independent predictors for the risk of rupture intraoperatively and for the postsurgical outcome were the presence of SAH, location on the M2-segment, size (DBD), and the broadness of the neck.

Nuances of Middle Cerebral Artery Aneurysm Microsurgery

Neurosurgery ◽  
2001 ◽  
Vol 48 (2) ◽  
pp. 339-346 ◽  
Author(s):  
Douglas Chyatte ◽  
Rebecca Porterfield
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Surgical Anatomy ◽  
Surgical Approaches ◽  
Common Source ◽  
Transsylvian Approach ◽  
Microsurgical Clipping ◽  
Technical Requirements ◽  
Middle Cerebral Artery Aneurysms

Abstract Middle cerebral artery aneurysms, a common source of subarachnoid hemorrhage, occur predominantly at the main bifurcation of the middle cerebral artery. Microsurgical clipping is the most effective treatment of these aneurysms because of their peripheral location, wide necks, and straightforward surgical anatomy. Despite the moderate technical requirements of this type of surgery, patients with ruptured aneurysms often have poor outcomes because of the high incidence of intracerebral hematomas. Although several different surgical approaches can be used, we favor a lateral-to-medial transsylvian approach for most aneurysms. This description of our surgical technique stresses minimizing retraction to avoid injury to the brain and preparing broad-based middle cerebral artery aneurysms for clipping. Management of outcomes when using these techniques also is presented.

Midaortic Syndrome and Subarachnoid Hemorrhage Associated with Ruptured Middle Cerebral Artery Aneurysm: Case Report and Review of the Literature

Neurosurgery ◽  
2003 ◽  
Vol 52 (6) ◽  
pp. 1460-1464 ◽  
Author(s):  
Kayhan Kuzeyli ◽  
Ertuğrul Çakir ◽  
Hasan Dinç ◽  
Özgür Ç. Sayin
Keyword(s):  
Intracranial Aneurysm ◽  
Middle Cerebral Artery ◽  
Ct Angiography ◽  
Cerebral Artery ◽  
Abdominal Aorta ◽  
Three Dimensional ◽  
Artery Aneurysm ◽  
Midaortic Syndrome ◽  
Ruptured Intracranial Aneurysm ◽  
Mca Aneurysm

Abstract OBJECTIVE AND IMPORTANCE We describe the presentation, screening, management, and clinical outcome of a 21-year-old man who sought care for a ruptured middle cerebral artery (MCA) aneurysm and midaortic syndrome (MAS). Only three cases of MAS and intracranial aneurysm rupture have previously been described in the literature. CLINICAL PRESENTATION Cranial computed tomographic (CT) scanning, cerebral and abdominal angiography, and multislice three-dimensional CT angiography were used to evaluate intracerebral hemorrhage and to assess medically intractable hypertension in the patient. Digital subtraction angiography revealed a right MCA aneurysm, and multislice three-dimensional CT angiography revealed narrowing of the abdominal aorta. INTERVENTION The patient's right MCA aneurysm was successfully clipped via a right pterional craniotomy. A narrowed abdominal aorta was confirmed by an abdominal aortic angiogram (performed at Day 5 after surgery) and then dilated by using percutaneous transcatheter angioplasty during the same session. The patient was normotensive even without antihypertensive medications. Neurological examination and postoperative cranial CT findings were within normal limits at the last follow-up examination, performed 4 months after the operation. CONCLUSION Our patient is the first reported case of ruptured MCA aneurysm with MAS in an adult. The most important problem in the management of MAS associated with ruptured intracranial aneurysm is medically intractable hypertension, which may markedly increase the incidence of rebleeding. It is hard to achieve normotension unless the narrowed aorta and its branches are dilated. For these reasons, MAS should be considered in patients with medically intractable hypertension associated with ruptured intracranial aneurysm.

MORPHOLOGICAL DIFFERENCES BETWEEN RUPTURED AND UNRUPTURED CASES IN MIDDLE CEREBRAL ARTERY ANEURYSMS

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 602-609 ◽  
Author(s):  
Takashi Sadatomo ◽  
Kiyoshi Yuki ◽  
Keisuke Migita ◽  
Eiji Taniguchi ◽  
Yasunori Kodama ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Three Dimensional ◽  
Artery Aneurysm ◽  
Parent Artery ◽  
Unruptured Aneurysms ◽  
Type D ◽  
Type C ◽  
Morphological Differences ◽  
Middle Cerebral Artery Aneurysms

Abstract OBJECTIVE To elucidate the morphological differences between ruptured and unruptured aneurysms, three-dimensional digital subtraction angiography was performed in 44 cases (20 unruptured, 24 ruptured) of middle cerebral artery aneurysm. METHODS When the neck was located on the extension of the midline of the parent artery, it was defined as Type C; when it was not, it was defined as Type D. Aspect ratio (AP ratio; dome/neck ratio) and daughter artery ratio (DA ratio; diameter of the larger daughter artery/diameter of the smaller daughter artery) were calculated, and these ratios were compared for ruptured and unruptured cases. RESULTS Nineteen cases were Type C and 25 cases were Type D. χ2 test revealed that there were significantly more ruptured cases among Type C (14 out of 19) compared with Type D (10 out of 25) (P &lt; 0.05). AP ratios were 2.24 ± 0.75 for ruptured cases and 1.56 ± 0.58 for unruptured cases. DA ratios were 1.53 ± 0.54 in ruptured cases and 2.14 ± 0.80 for unruptured cases. Both showed significant differences (P &lt; 0.01). In cases with an AP ratio of 1.8 or greater and a DA ratio less than 1.7, 13 out of 15 (87%) were ruptured cases. On the contrary, in cases with an AP ratio less than 1.8 and a DA ratio of 1.7 or greater, 12 out of 13 (92%) were unruptured cases. CONCLUSION Type C and equality of the diameters of two daughter arteries, together with high AP ratios, seem to be morphological factors that associate with aneurysmal rupture.

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