Morphological Parameters Associated With Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2015 ◽  
Vol 76 (6) ◽  
pp. 721-727 ◽  
Author(s):  
Anil Can ◽  
Allen L. Ho ◽  
Ruben Dammers ◽  
Clemens M.F. Dirven ◽  
Rose Du
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Vascular Malformations ◽  
Statistical Significance ◽  
Source Image ◽  
Parent Artery ◽  
Morphological Parameters ◽  
Daughter Branch ◽  
Group A ◽  
Group B

Abstract BACKGROUND: Morphological factors contribute to the hemodynamics of the middle cerebral artery (MCA). OBJECTIVE: To identify image-based morphological parameters that correlated with the presence of MCA aneurysms. METHODS: Image-based anatomic parameters obtained from 110 patients with and without MCA bifurcation aneurysms were evaluated with Slicer, an open-source image analysis software, to generate 3-dimensional models of the aneurysms and surrounding vascular architecture. We examined segment lengths, diameters, and vessel-to-vessel angles of the parent and daughter vessels at the MCA bifurcation. In order to reduce confounding by genetic and clinical risk factors, 2 control groups were selected: group A (the unaffected contralateral side of patients with unilateral MCA bifurcation aneurysms) and group B (patients without intracranial aneurysms or other vascular malformations). Univariate and multivariate analyses were performed to determine statistical significance. RESULTS: One hundred ten patients who were evaluated from 2007 to 2014 were analyzed (73 patients with MCA aneurysms and 37 control patients). Multivariate analysis revealed that a smaller parent artery diameter (group A: odds ratio [OR] 0.20, P < .01, group B: OR 0.23, P < .01) and a larger daughter-to-daughter branch angle (group A: OR 1.01, P = .04, group B: OR 1.02, P = .04) were most strongly associated with MCA aneurysm presence after adjusting for other morphological factors. CONCLUSION: Smaller parent artery diameter and larger daughter-to-daughter branch angles are associated with the presence of MCA bifurcation aneurysms. These easily measurable parameters may provide objective metrics to assess aneurysm formation and growth risk stratification in high-risk patients.

scholarly journals Parasympathetic Denervation of Rat Pial Vessels Significantly Increases Infarction Volume following Middle Cerebral Artery Occlusion

1991 ◽  
Vol 11 (4) ◽  
pp. 628-637 ◽  
Author(s):  
Michihisa Kano ◽  
Michael A. Moskowitz ◽  
Masayuki Yokota
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Focal Cerebral Ischemia ◽  
Protective Role ◽  
Artery Occlusion ◽  
Nerve Fibers ◽  
Infarction Volume ◽  
Cortical Gray Matter ◽  
Group A ◽  
Group B

Studies were undertaken in Long Evans rats to examine the hypothesis that chronic unilateral sectioning of vasodilating nerve fibers (parasympathetic and/or sensory) innervating the circle of Willis increases infarction volume following unilateral branch occlusion of the middle cerebral artery (MCA) combined with temporary (45 min) bilateral common carotid occlusion. Infarct size was measured 24 h after surgical occlusion from seven coronal slices. Infarction volume (mean ± SD) in sham animals (group A) and surgically naive animals (group B) measured 153 ± 43 and 131 ± 38 mm3, respectively. After lesions of both sensory (nasociliary nerve) and parasympathetic efferents at the ethmoidal foramen (group C, combined lesion) or selective lesions of parasympathetic efferents (group D), infarction volume increased [214 ± 47 mm3 (p < 0.01) and 209 ± 46 mm3 (p < 0.05), respectively]. No increases were detected after cutting the nasociliary nerve alone (group E) or occluding the external ethmoidal artery (group F) [145 ± 39 mm3 (p > 0.05) and 124 ± 63 mm3 (p > 0.05), respectively]. The infarct was predominantly located within cortical gray matter and became enlarged on its superior and inferior aspects after parasympathectomy. Large infarcts were noted whether animals breathed spontaneously (all of the above) or were artificially respired or whether animals were anesthetized with xylazine and ketamine or chloral hydrate. Taken together, these studies suggest a previously unrecognized protective role for autonomic parasympathetic fibers in the pathophysiology of focal cerebral ischemia that is not shared by sensory fibers. The importance of autonomic vasodilating fibers to blood flow in ischemic brain merits further study.

The branching pattern of the middle cerebral artery: is the intermediate trunk real or not? An anatomical study correlating with simple angiography

2012 ◽  
Vol 116 (5) ◽  
pp. 1024-1034 ◽  
Author(s):  
Gokmen Kahilogullari ◽  
Hasan Caglar Ugur ◽  
Ayhan Comert ◽  
Ibrahim Tekdemir ◽  
Yucel Kanpolat
Keyword(s):  
Motor Cortex ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cerebral Angiography ◽  
Bifurcation Point ◽  
Point Group ◽  
3D Ct ◽  
Type Group ◽  
Group A ◽  
Group B

Object The branching structure of the middle cerebral artery (MCA) remains a debated issue. In this study the authors aimed to describe this branching structure in detail. Methods Twenty-seven fresh, human brains (54 hemispheres) obtained from routine autopsies were used. The cerebral arteries were first filled with colored latex and contrast agent, followed by fixation with formaldehyde. All dissections were done under a microscope. During examination, the trunk structures of the MCA and their relations with cortical branches were demonstrated. Lateral radiographs of the same hemispheres were then obtained and comparisons were made. Angles between the MCA trunks were measured on 3D CT cerebral angiography images in 25 patients (50 hemispheres), and their correlations with the angles obtained in the cadaver brains were evaluated. Results A new classification was made in relation to the terminology of the intermediate trunk, which is still a subject of debate. The intermediate trunk was present in 61% of cadavers and originated from a superior trunk in 55% and from an inferior trunk in 45%. Cortical branches supplying the motor cortex (precentral, central, and postcentral arteries) significantly originated from the intermediate trunk, and the diameter of the intermediate trunk significantly increased when it originated from the superior trunk. In measurements of the angles between the superior and intermediate trunks, it was found that the intermediate trunk had significant dominance in supplying the motor cortex as the angle increased. The intermediate trunk was classified into 3 types based on the angle values and the distance to the bifurcation point as Group A (pseudotrifurcation type), Group B (proximal type), and Group C (distal type). Group A trunks were seemingly closer to the trifurcation structure that has been reported on in the literature and was seen in 15%. Group B trunks were the most common type (55%), and Group C trunks were characterized as the farthest from the bifurcation point. Group C trunks also had the smallest diameter and fewest cortical branches. Similarities were found between the angles in cadaver specimens and on 3D CT cerebral angiography images. Beyond the separation point of the MCA, trunk structures always included the superior trunk and inferior trunk, and sometimes the intermediate trunk. Conclusions Interrelations of these vascular structures and their influences on the cortical branches originating from them are clinically important. The information presented in this study will ensure reliable diagnostic approaches and safer surgical interventions, particularly with MCA selective angiography.

scholarly journals Simultaneous Combined Intravenous Recombinant Tissue Plasminogen Activator and Endovascular Therapy for Hyperacute Middle Cerebral Artery M1 Occlusion

2011 ◽  
Vol 17 (1) ◽  
pp. 115-122 ◽  
Author(s):  
S. Toyota ◽  
S. Sugiura ◽  
K. Iwaisako
Keyword(s):  
Middle Cerebral Artery ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Cerebral Artery ◽  
Endovascular Therapy ◽  
Recombinant Tissue Plasminogen Activator ◽  
Simultaneous Treatment ◽  
Tissue Plasminogen ◽  
Group A ◽  
Group B

We investigated the efficacy and safety of combined intravenous (IV) recombinant tissue plasminogen activator (rtPA) and simultaneous endovascular therapy (ET) for hyperacute middle cerebral artery (MCA) M1 occlusion. Between October 2005 and April 2007, in the combined group, 22 patients eligible for IV rtPA, who were diagnosed as having MCA M1 occlusion, were treated with IV rtPA and simultaneous ET was initiated as soon as possible. The other patients were treated with IV rtPA alone (IV group A: n = 11). Between May 2007 and November 2008, all patients eligible for IV rtPA, who were diagnosed as having MCA M1 occlusion, underwent thrombolysis by IV rtPA alone (IV group B: n = 24). The improvement of the National Institutes of Health Stroke Scale score at 24 hours was highest in the combined group (10 ± 4.1). In contrast, it was 5.1 ± 4.7 in the IV group A (P = 0.017) and 5.6 ± 5.6 in IV group B (P = 0.006). In the combined group, successful recanalization was observed in 18 of 22 patients with one symptomatic intracranial hemorrhage. The rate of mRS0–2 at three months was highest in the combined group, 36% in the IV group A and 33% in the IV group B (P = 0.008). Simultaneous treatment with IV rtPA and ET improved the clinical outcome of MCA M1 occlusion without a significant increase of adverse effects in our study.

scholarly journals Study of fetal doppler velocimetry versus non stress test as predictors of adverse perinatal outcome in high risk pregnancies

2020 ◽  
Vol 9 (2) ◽  
pp. 729
Author(s):  
Hymavathi K. ◽  
Prasuna P. ◽  
Davuluru Sandhya Rani
Keyword(s):  
High Risk ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Perinatal Outcome ◽  
Stress Test ◽  
Doppler Velocimetry ◽  
Group A ◽  
Group B ◽  
Group D ◽  
Fetal Compromise

Background: Pregnancy is a unique, physiologically normal event in a women’s life. Objective of this study was to compare the efficacy of the doppler velocimetry versus non stress test in relation to perinatal outcome in high risk pregnancies.Methods: This is a prospective study conducted in the department of obstetrics and gynaecology, Narayana Medical College and Hospital. 100 women with high risk pregnancy were recruited. All were examined systematically, and Doppler velocimetry and non-stress test were done.Results: All cases were divided into four groups based on NST and doppler velocimetry of umbilical artery and middle cerebral artery. 10% of women had abnormal doppler. Middle cerebral artery doppler abnormality was noted in 3% and CPR abnormality in 3% of women in the study group. 15% had abnormal NST. In Group A, out of 88 patients 9 had fetal compromise. In Group B, out of 5 patients all had fetal compromise. In Group C, out of 4 patients none had fetal compromise. In Group D, all 3 patients had fetal compromise. In Group D, all 3 had neonatal deaths. Average birth weights in Group A was 2.7 kg, in Group B was 2 kg, in Group C was 2.5 kg, in Group D was 1.4 kg. Two (2.2%) newborn in Group A, 4 (80%) newborns in Group B, 3 (100%) in Group had Apgar < 7 at 5 minutes. 4 (4.5%) babies in Group A, 5 (100%) babies in Group B, 3 (100%) babies in Group D were admitted in NICU. Umbilical artery doppler was found to have sensitivity 46.6%, specificity - 94%, PPV - 93%, NPV - 54%. Middle cerebral artery doppler was found to have sensitivity 73.3%, specificity - 90%, PPV - 91.6%, NPV- 69.3%.Conclusions: In present study, highest percentage of perinatal complications and perinatal deaths were seen in groups with abnormal tests of NST and velocimetry. Group D had the worst perinatal outcome.

Morphology parameters for rupture in middle cerebral artery mirror aneurysms

2020 ◽  
Vol 12 (9) ◽  
pp. 858-861 ◽  
Author(s):  
Wei-dong Xu ◽  
Han Wang ◽  
Qi Wu ◽  
Li-Li Wen ◽  
Zong-qi You ◽  
...  
Keyword(s):  
Risk Factors ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Significant Risk ◽  
Maximum Diameter ◽  
Parent Artery ◽  
Morphological Parameters ◽  
Operating Characteristics ◽  
Neck Width ◽  
Independent Risk Factors

ObjectiveTo identify the morphological parameters correlated with the rupture of middle cerebral artery (MCA) aneurysms.MethodsWe retrospectively analyzed the digital subtraction angiography (DSA) data of 48 patients with ruptured mirror MCA aneurysms. Morphological parameters included aneurysm with wall protrusion, maximum diameter (Dmax), height, neck width, aneurysm width, dome projection, parent artery average diameter (Dp), aspect ratio (AR), bottleneck factor (BNF), size ratio (SR), M1/M2 ratio, and height/width (H/W) ratio. These paired parameters were analyzed by conditional univariate and multivariate logistic regressions to screen out the independent risk factors. We established a score based on the independent risk factors. Receiver operating characteristics (ROC) were generated to estimate the prediction performance of the score in our large database of 763 aneurysms.ResultsIn the univariate regressions, Dmax, height, aneurysm width, neck width, AR, BNF, H/W ratio, SR, anterior dome projection and aneurysm with wall protrusion were significant risk factors. Aneurysm width (OR 3.296, p=0.015), AR (OR 11.594, p=0.014) and anterior dome projection (OR 9.385, p=0.016) were independent risk factors in multivariate regression. The area under the curve (AUC) value of the score based on the three independent risk factors was 0.829.ConclusionAneurysm width, AR and anterior dome projection were independent risks factors of rupture.

scholarly journals The Influence of the Physiotherapeutic Program on Selected Static and Dynamic Foot Indicators and the Balance of Elderly Women Depending on the Ground Stability

2021 ◽  
Vol 18 (9) ◽  
pp. 4660
Author(s):  
Joanna Matla ◽  
Katarzyna Filar-Mierzwa ◽  
Anna Ścisłowska-Czarnecka ◽  
Agnieszka Jankowicz-Szymańska ◽  
Aneta Bac
Keyword(s):  
Elderly Women ◽  
Statistical Significance ◽  
Exercise Program ◽  
Control Group ◽  
Balance Assessment ◽  
Motor Functions ◽  
Static Test ◽  
Group A ◽  
Group B ◽  
The Impact

Seniors are a constantly growing group of people in many societies. It is necessary to develop physiotherapeutic programs to improve their mobility. The aim of this study was to assess the impact of the physiotherapeutic program conducted unstable ground on selected indicators of motor functions of elderly women. Sixty women (60–80 years) participated in the research. Group A (N = 20) underwent a 12-week physiotherapeutic program on stable ground, group B (N = 20) followed an exercise program on unstable ground, and group C (N = 20) (control group) had no therapeutic intervention. The effects of the therapy were assessed by using a FreeMed platform (foot load analysis) and a Biosway balance system. The results were compared using ANOVA (the one-way analysis), the Kruskal–Wallis test and also the post hoc tests (Tukey’s test and the multiple comparison test). In group A, a statistically significant change was observed in the static test and balance assessment, in group B this was observed in the static and dynamic foot tests and balance assessment, in group C, no statistical significance was achieved. The authors’ physiotherapeutic program had a statistically significant effect on changes in the balance and selected indicators of the motor functions of the examined people. Comparing the results before and after the therapy more improvement changes were noted in women training on an unstable ground compared to women training on a stable ground.

scholarly journals Marginal Integrity of CAD/CAM Ceramic Crowns Using Two Different Finish Line Designs

2021 ◽  
Author(s):  
Jaber Hussain Akbar ◽  
Ridwaan Omar ◽  
Yacoub Al Tarakmah
Keyword(s):  
Dental Treatment ◽  
Statistical Significance ◽  
United States Public Health ◽  
Finish Line ◽  
Marginal Integrity ◽  
Computer Aided ◽  
Cad Cam ◽  
Group A ◽  
Group B ◽  
Line Design

Statement of problem- Research on evaluation of crowns made by the latest CAD/CAM systems for their marginal adaptation is scarce. Purpose- The purpose of this in vitro study was to evaluate the marginal integrity of crowns fabricated by the latest Chairside Economical Restorations of Esthetic Ceramic (CEREC) system using two different finish line preparation designs: Chamfer and Shoulder. Material and methods- Typhodont teeth were equally divided into two groups, group A and B. The teeth were prepared for full coverage crowns with a shoulder (group A) and chamfer finish line design (group B). An experienced prosthodontist prepared all crown preparations. Evaluation of six sites per sample was completed by two calibrated, experienced prosthodontists using the modified United States Public Health Services (USPHS) criteria. The descriptive statistics and Z-test were used to evaluate the results. Results- A total of 180 teeth were included in the study (90 teeth in each group). Only two crowns in group A and one crown in group B were clinically unacceptable. There was no statistical significance (p=0.282) between the two groups regarding finish-line design. Conclusions- CEREC system provides clinically acceptable crowns and can safely be utilized in dental treatment. Therefore, Contemporary Dental Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) restorations should be considered as a safe treatment modality by dental professionals.

Republished: Successful treatment of ruptured multiple fusiform middle cerebral artery aneurysms with silk vista baby flow diverter in a 10-months-old infant

2021 ◽  
pp. neurintsurg-2021-017554.rep
Author(s):  
Giovanni Barchetti ◽  
Loris Di Clemente ◽  
Mauro Mazzetto ◽  
Mariano Zanusso ◽  
Paola Ferrarese ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Successful Treatment ◽  
Expectant Management ◽  
Flow Diverter ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Microsurgical Clipping ◽  
Parent Artery Occlusion ◽  
The Right

We report the successful treatment of multiple ruptured fusiform middle cerebral artery (MCA) aneurysms in a 10-month-old girl. This previously healthy infant presented with subarachnoid haemorrhage and was found to have multiple irregular dilatations of the superior division branch of the right MCA. Cerebral angiography was performed and confirmed the presence of multiple fusiform aneurysms of the MCA. After multidisciplinary team discussion, it was decided to treat the aneurysms with endovascular approach, using a flow-diverter. Microsurgical clipping was deemed risky because of the high likelihood of parent artery occlusion and expectant management was also considered inappropriate because of the risk of re-bleeding. Dual antiplatelet therapy was started, and a flow-diverter was successfully delivered in the superior division branch of the right MCA. The post-operative course was uneventful, MRI at 12 months did not show any sign of recurrence and at 3 years of age the patient had a normal neurological examination.

scholarly journals A Combined Approach to Treatment of the Dissecting Middle Cerebral Artery Fusiform Aneurysm

2009 ◽  
Vol 15 (3) ◽  
pp. 349-354 ◽  
Author(s):  
T. Hrbáč ◽  
P. Drábek ◽  
P. Klement ◽  
V. Procházka
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Fusiform Aneurysm ◽  
Neurological Sequelae ◽  
Parent Artery Occlusion ◽  
Aneurysm Embolization ◽  
Mca Aneurysm ◽  
One Year

A fusiform aneurysm in the terminal M1 middle cerebral artery (MCA) segment was treated by a construction of a high-flow arterial extracranial-intracranial (EC-IC) bypass. Due to severe bypass vasospasms, local vasodilating agents together with percutaneous angioplasty and stent implantation were applied, but failed due to subsequent bypass occlusion. To remedy this complication a new bypass was created from a segment of the saphenous vein, followed by MCA aneurysm embolization and parent artery occlusion. One year after the surgery, the venous bypass remains patent and the aneurysm occluded, with the patient fully active, without any neurological sequelae.

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