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.

Surgical clipping of a large left middle cerebral artery aneurysm

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.

scholarly journals Suprapraorbital “key-hole” Approach for Surgical Treatment of Middle Cerebral Artery Aneurysms

2018 ◽  
Vol 27 (4) ◽  
pp. 346-351
Author(s):  
Alexandre Haddad De Souza ◽  
Juan Antonio Castro Flores ◽  
Carlos Eduardo Roelke ◽  
Felipe Romero Vera ◽  
José Carlos Esteves Veiga
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Surgical Instruments ◽  
Field Exposure ◽  
Incidental Aneurysms ◽  
Surgical Field ◽  
Surgical Corridor ◽  
Middle Cerebral Artery Aneurysms ◽  
Cerebral Artery Aneurysm

Objective. To describe details and technical difficulties observed in the use of this access for the treatment of middle cerebral artery aneurysms. Methods. This is a retrospective study including 15 patients with middle cerebral artery aneurysm operated on using this technique (two ruptured aneurysms and 13 incidental aneurysms). We considered age, gender, laterality of the aneurysm, and whether it was ruptured. We evaluated the surgical corridor (surgical field exposure and ease of handling of the surgical instruments), surgery time, complications, functional and cosmetic results. Results. This access provides adequate exposure of the surgical field, but the restricted working angle makes it difficult to dissect the aneurysm and, especially, to place the definitive clip. Conclusion. The restriction of the working angle may compromise the safety of the surgery. It is important to determine the specific indications for this access, particularly in cases of incidental aneurysms.

scholarly journals Morphological and Hemodynamic Risk Factors for Middle Cerebral Artery Aneurysm: a Case-Control Study of 190 Patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Wojciech Kaspera ◽  
Karolina Ćmiel-Smorzyk ◽  
Wojciech Wolański ◽  
Edyta Kawlewska ◽  
Anna Hebda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Case Control Study ◽  
Artery Aneurysm ◽  
Case Control ◽  
Middle Cerebral Artery Aneurysm ◽  
Cerebral Artery Aneurysm ◽  
Control Study

scholarly journals Prognostic factors of ruptured middle cerebral artery aneurysms treated with surgical clipping

2020 ◽  
pp. 245-253
Author(s):  
Samer S. Hoz ◽  
Saja A. Albanaa ◽  
Ali M. Neamah ◽  
Farah W. Abdulmohsin ◽  
Zahraa Al-Sharshahi
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Middle Cerebral Artery Aneurysm ◽  
Surgical Clipping ◽  
Unruptured Aneurysms ◽  
Surgical Data ◽  
Middle Cerebral Artery Aneurysms ◽  
Cerebral Artery Aneurysm ◽  
The Relationship

Background: Spontaneous subarachnoid haemorrhage is an emergent condition that leads to profound morbidity and mortality. It is mainly caused by a ruptured intracranial aneurysm. Herein we described the relationship of different factors and their impact on the outcome of patients who underwent a surgical clipping exclusively to the ruptured middle cerebral artery aneurysm. Methods: We retrospectively analyzed the medical records of patients admitted to the Neurosurgery Teaching Hospital (NTH) in Baghdad for the period between January 2017-April 2019 of patients who underwent microsurgical clipping for ruptured middle cerebral artery aneurysm. Demographic, clinical, radiological and surgical data were extracted. A univariate analysis was used to illustrate the relationship between the variables and outcome which was assessed using the five scores of the Glasgow Outcome Scale where patients were dichotomized into two groups; favourable (IV + V) and unfavourable (I, II, III). Results: Within this cohort, a total of 50 patients were studied and the analysis revealed that 92% (N=46) had a favourable outcome and 8% (N=4) had an unfavourable outcome at discharge. The in-hospital mortality was 6%(N=3). Factors that were significantly associated with poor outcome were giant aneurysms, the presence of other unruptured aneurysms, post-operative clinical vasospasm, presence of contralateral weakness, lower pre/post-operative Glasgow coma scores, higher Hunt and Hess, World Federation of Neurosurgical Societies (WFNS) and modified-WFNS grades. Conclusion:  The factors with a significant impact on the outcome of patients with surgically clipped ruptured middle cerebral artery aneurysms were GCS, WFNS, m-WFNS, H&H, contralateral muscle weakness, size of the aneurysm, presence of other unruptured aneurysms and clinical vasospasm.

scholarly journals Middle Cerebral Artery Aneurysm Coiling without Assisted Techniques – A Good Alternative, Single Venture Experience

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
UMAIR RASHID CH ◽  
SAIMA AHMED ◽  
SOHAIL AKHTAR
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Good Alternative ◽  
Number Of Patients ◽  
Middle Cerebral Artery Aneurysms ◽  
Cerebral Artery Aneurysm ◽  
Sixth Decade ◽  
Aneurysm Coiling

Objective:  To evaluate the result of a coiling of middle cerebral artery aneurysms without auxiliary techniques. Material and Methods:  This study was conducted from June 2010 to September 2019 in the Department of Neuroradiology, Punjab Institute of Neurosciences, Lahore. There were a total of 500 patients with unilateral and bilateral cerebral aneurysms at the MCA level that have been included in this study which comprise of both sexes. Results:  There was a total of 500 patients, which comprised of 200 (40%) men and 300 (60%) women. Their ages ranged from 22 to 65 years. The majority number of patients was in their fifth 180 (30%) and sixth decade 150 (30%) of life. In our study, a successful coiling was performed in 490 (98%) patients with minimal re-canalization of MCA aneurysms. In 10 (2%) procedure was unsuccessful due to vasospasm. Conclusion:  The conventional coiling in middle cerebral artery aneurysms can be effective and safe without auxiliary techniques.

Ruptured Middle Cerebral Artery Aneurysm Presenting with Hematoma

2019 ◽  
pp. 47-60
Author(s):  
Joseph M. Zabramski
Keyword(s):  
Decision Making ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Operative Management ◽  
Surgical Emergencies ◽  
Middle Cerebral Artery Aneurysms ◽  
Cerebral Artery Aneurysm ◽  
Clot Evacuation

Abstract: This chapter reviews the surgical management of ruptured middle cerebral artery aneurysms associated with hematoma. Ruptured middle cerebral artery aneurysms occasionally present with mass effect from a large subarachnoid and/or intraparenchymal hematoma. In the case of significant hematoma size, midline shift, or increased intracranial pressure, these lesions are surgical emergencies. They can present significant management challenges because the presence of the hematoma makes operative management more difficult. Given the large and functionally critical territory supplied by the middle cerebral artery, preservation of the both the afferent and efferent branches is critical. Decision-making regarding the timing and strategy of clot evacuation is discussed.

scholarly journals Technical nuances of clipping a middle cerebral artery bifurcation aneurysm

2015 ◽  
Vol 39 (videosuppl1) ◽  
pp. V2
Author(s):  
Piyush Kalakoti ◽  
Shyamal C. Bir ◽  
Richard D. Murray ◽  
Osama Ahmed ◽  
Anil Nanda
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Middle Cerebral Artery Aneurysm ◽  
Postoperative Course ◽  
Microsurgical Clipping ◽  
Bifurcation Aneurysm ◽  
Middle Cerebral Artery Aneurysms ◽  
Intraoperative Rupture ◽  
Cerebral Artery Aneurysm

Broad-necked middle cerebral artery aneurysms present unique challenges for the vascular neurosurgeon, who must contend with smaller vessels and often a complex clipping strategy. Due to their superficial location, these lesions are still commonly selected for microsurgical clipping. We present a case of a 42-year-old woman with significant vascular disease with a right middle cerebral artery aneurysm. We discuss the key surgical steps, demonstrate the microsurgical dissection and intraoperative rupture encountered and the final clipping strategy, as well as the postoperative course in this operative video presentation.The video can be found here: http://youtu.be/qZ2gvqz7XdQ.

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