ENDOVASCULAR TREATMENT OF MIDDLE CEREBRAL ARTERY ANEURYSMS WITH DETACHABLE COILS

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 876-889 ◽  
Author(s):  
Shuichi Suzuki ◽  
Satoshi Tateshima ◽  
Reza Jahan ◽  
Gary R. Duckwiler ◽  
Yuichi Murayama ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Bypass Surgery ◽  
Combined Treatment ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Surgical Clipping ◽  
Endovascular Coil Embolization

Abstract OBJECTIVE Because of their anatomic configuration, middle cerebral artery (MCA) aneurysms are most often treated with surgical clipping. However, endovascular coil embolization of these aneurysms is an increasingly used alternative. We retrospectively reviewed the anatomic and clinical outcomes of patients with MCA aneurysms who underwent endovascular treatment at our institution. METHODS One hundred fifteen MCA aneurysms in 115 patients (mean age, 55.1 years) were treated by an endovascular technique from April 1990 to March 2007. Forty-eight patients (42%) presented with acute subarachnoid hemorrhage, and 67 patients (58%) had unruptured aneurysms. Fifty-three aneurysms (46%) were small with a small neck, 28 (24%) were small with a wide neck, 22 (19%) were large, and 12 (11%) were giant. RESULTS Angiographic results immediately after embolization showed complete occlusion in 53 aneurysms (46%), a neck remnant in 51 (44%), and incomplete occlusion in 3 (3%). Because of anatomic difficulties, we could not embolize 8 aneurysms (7%). Thirteen patients underwent combined treatment that included endovascular and extracranial-intracranial bypass surgery. Morbidity and mortality rates were 6.9% (8 patients) and 3% (3 patients), respectively. Procedure-related complications were encountered in 10 patients (9%). Seventy patients had long-term follow-up angiograms. Seven aneurysms (10%) were recanalized; all were large or giant. One partially embolized large aneurysm ruptured 13 months after embolization. CONCLUSION In this series, endovascular coil embolization of MCA aneurysms has morbidity and mortality rates comparable to those of conventional surgical clipping. Combined treatment of endovascular and bypass surgery can successfully treat large or giant complex fusiform MCA aneurysms.

Intracerebral malignant peripheral nerve sheath tumor in a child with neurofibromatosis Type 1 and middle cerebral artery aneurysm treated with endovascular coil embolization

2011 ◽  
Vol 8 (4) ◽  
pp. 346-352 ◽  
Author(s):  
Michael J. Ellis ◽  
Samuel Cheshier ◽  
Sunjay Sharma ◽  
Derek Armstrong ◽  
Cynthia Hawkins ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Neurofibromatosis Type 1 ◽  
Coil Embolization ◽  
Neurofibromatosis Type ◽  
Nerve Sheath Tumor ◽  
Nerve Sheath ◽  
Endovascular Coil Embolization

Among the neoplastic conditions that affect patients with neurofibromatosis Type 1 (NF1) are malignant peripheral nerve sheath tumors (MPNSTs), which typically arise from peripheral nerves of the limbs, trunk, and lumbar and brachial plexuses. Ionizing radiation is an established risk factor for MPNST development, especially in susceptible patients such as those with NF1. Patients with NF1 are also at risk for intracranial aneurysms, which are increasingly being successfully managed with endovascular therapies. The authors describe the case of a 9-year-old, previously healthy girl who presented in extremis with a right frontal intracerebral hemorrhage resulting from a ruptured right middle cerebral artery (MCA) trifurcation aneurysm. Following urgent decompressive craniectomy, the patient underwent endovascular coil embolization of the MCA aneurysm without complication. Given her mother's history of NF1, the child underwent genetic testing, which disclosed signs positive for NF1. The patient recovered well, but follow-up MR imaging and MR angiography performed at 14 months demonstrated a large frontotemporal mass encasing the right MCA trifurcation. The patient underwent frontotemporal craniotomy and subtotal resection of the mass, which was histologically found to be an intracranial MPNST. The patient received chemotherapy and focal radiation therapy and remains alive at 6 months postresection. To the authors' knowledge, this represents the only known case of intracranial neoplasm arising in the region of an intracranial aneurysm repaired by endovascular coil embolization. While patients with NF1 represent a population with genetic susceptibility to radiation-induced tumors, the pathogenesis of intracerebral MPNSTs remains poorly understood.

P-016 The last frontier in endovascular coil embolization: the middle cerebral artery bifurcation aneurysms

2018 ◽  
Author(s):  
R Kellogg ◽  
I Chaudry ◽  
A Turk ◽  
R Turner ◽  
A Spiotta
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Endovascular Coil Embolization

Endovascular coil embolization of middle cerebral artery aneurysms of the proximal (M1) segment

2013 ◽  
Vol 55 (9) ◽  
pp. 1097-1102 ◽  
Author(s):  
Young Dae Cho ◽  
Woong Jae Lee ◽  
Kang Min Kim ◽  
Hyun-Seung Kang ◽  
Jeong Eun Kim ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Endovascular Coil Embolization ◽  
Middle Cerebral Artery Aneurysms

scholarly journals Endovascular Treatment of Distal Posterior Cerebral Artery Infectious Aneurysm

2020 ◽  
Vol 17 (3) ◽  
pp. 50-54
Author(s):  
Manoj Bohara ◽  
Prakash Bista
Keyword(s):  
Infective Endocarditis ◽  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Posterior Cerebral Artery ◽  
Parent Artery ◽  
Cerebral Angiogram ◽  
Endovascular Coil Embolization ◽  
Intracranial Infectious Aneurysm ◽  
Infectious Aneurysm

Intracranial infectious aneurysms are rare entities accounting for approximately 1- 6 % of all cerebral aneurysms and have high propensity of rupture associated with mortality. The principal risk factor is infective endocarditis and the management includes antimicrobial treatment with or without obliteration of the aneurysm by microsurgical or endovascular means. We present a young patient with intracranial infectious aneurysm who was successfully treated with endovascular coil embolization. A 20-years-old female with history of rheumatic heart disease presented with subarachnoid hemorrhage due to rupture of IIA associated with infective endocarditis. Cerebral angiogram revealed right distal posterior cerebral artery aneurysm. Echocardiography showed vegetation in mitral valve and blood culture was positive for Enterococcus faecalis. Antibiotic treatment was administered for 6 weeks. The follow-up angiogram showed an enlarging aneurysm. So, the patient underwent endovascular coil embolization of the aneurysm preserving the parent artery. There were no post-procedure deficits. Intracranial infectious aneurysm should be considered as a differential diagnosis in a patient with infective endocarditis presenting with focal neurological deficits or altered consciousness. Early diagnosis and individualized approach are the key to successful treatment and endovascular treatment is an effective modality for such lesions.

scholarly journals Endovascular coil embolization of proximal middle cerebral artery aneurysms has better outcomes than other middle cerebral artery aneurysms: A retrospective study

2020 ◽  
Vol 26 (3) ◽  
pp. 268-274
Author(s):  
Hirotaka Sato ◽  
Koichi Haraguchi ◽  
Yasuhiro Takahashi ◽  
Shunya Ohtaki ◽  
Tadakazu Shimizu ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Univariate Analysis ◽  
Insular Cortex ◽  
Class 1 ◽  
Endovascular Coil Embolization ◽  
Proximal Middle Cerebral Artery ◽  
Operative Notes ◽  
Middle Cerebral Artery Aneurysms

Purpose Although some authors proposed that coil embolization in middle cerebral artery (MCA) aneurysms is a useful and effective alternative, the characteristics of the aneurysms may be different at each location. We compared the results of coil embolization of proximal middle cerebral artery aneurysms with those of other middle cerebral artery aneurysms. Methods Data from 46 patients with 50 aneurysms were retrospectively evaluated. We defined the aneurysms inside of the insular cortex as proximal MCA (pMCA) aneurysms and those outside of the insular cortex as non-proximal MCA (npMCA) aneurysms. The results of the occlusion were divided into classes 1, 2, and 3 of the Raymond scale. We collected the results of the occlusion from the operative notes supplied by a neuroendovascular specialist. Results Univariate analysis identified favorable results for pMCA aneurysms (class 1: pMCA = 22 npMCA = 11; P < 0.01). In the radiological follow-up results, we achieved class 1 in 29 patients (69%; pMCA = 21 and npMCA = 8; P < 0.01). Side wall type aneurysms (pMCA = 14, npMCA = 2; P < 0.01) and the number of branches from the neck of ≤1 (pMCA = 14, npMCA = 2; P < 0.01) were significantly recognized at the pMCA. Conclusions Proximal middle cerebral artery aneurysm clipping is difficult because the origin of the lenticulostriate arteries is often hidden behind the aneurysmal dome. In the present study, endovascular coil embolization for pMCA aneurysms obtained better results than that for npMCA aneurysms because of the morphological characteristics. Endovascular coil embolization seems to be efficacious for pMCA aneurysms as compared with npMCA aneurysms.

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