scholarly journals Middle cerebral artery revascularization: anatomical studies and considerations on the anastomosis site

1997 ◽  
Vol 55 (1) ◽  
pp. 16-23 ◽  
Author(s):  
Murilo S. Meneses ◽  
Ricardo Ramina ◽  
Andrea P. Jackowski ◽  
Ari A. Pedrozo ◽  
Robertson B. Pacheco ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Vascular Diseases ◽  
Anatomical Study ◽  
External Carotid Artery ◽  
External Carotid ◽  
Venous Graft

In the surgical management of skull base lesions and vascular diseases such as giant aneurysms, involvement of the internal carotid artery may require the resection or the occlusion of the vessel. The anastomosis of the external carotid artery and the middle cerebral artery with venous graft may be indicated to re-establish the blood flow. To determine the best suture site in the middle cerebral artery, an anatomical study was carried out. Fourteen cerebral hemispheres were analysed after the injection of red latex into the internal carotid artery. The superior and inferior trunk of the main division of the middle cerebral artery have more than 2 mm of diameter. They are superficial allowing an anastomosis using a venous graft. The superior trunk has a disadvantage, it gives rise to branches for the precentral and post-central giri. The anastomosis with the inferior trunk presents lower risk of neurological deficit even though the angular artery originates from it.

Blister Aneurysms of the Internal Carotid Artery: Microsurgical Results and Management Strategy

Neurosurgery ◽  
2017 ◽  
Vol 80 (2) ◽  
pp. 235-247 ◽  
Author(s):  
Christopher M. Owen ◽  
Nicola Montemurro ◽  
Michael T. Lawton
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Treatment Strategy ◽  
Internal Carotid ◽  
Artery Bypass ◽  
External Carotid ◽  
Parent Artery ◽  
Intraoperative Rupture

Abstract BACKGROUND: Blister aneurysms of the supraclinoid internal carotid artery (ICA) are challenging lesions with high intraoperative rupture rates and significant morbidity. An optimal treatment strategy for these aneurysms has not been established. OBJECTIVE: To analyze treatment strategy, operative techniques, and outcomes in a consecutive 17-year series of ICA blister aneurysms treated microsurgically. METHODS: Seventeen patients underwent blister aneurysm treatment with direct clipping, bypass and trapping, or clip-reinforced wrapping. RESULTS: Twelve aneurysms (71%) were treated with direct surgical clipping. Three patients required bypass: 1 superficial temporal artery to middle cerebral artery bypass, 1 external carotid artery to middle cerebral artery bypass, and 1 ICA to middle cerebral artery bypass. One patient was treated with clip-reinforced wrapping. Initial treatment strategy was enacted 71% of the time. Intraoperative rupture occurred in 7 patients (41%), doubling the rate of a poor outcome (57% vs 30% for patients with and without intraoperative rupture, respectively). Severe vasospasm developed in 9 of 16 patients (56%). Twelve patients (65%) were improved or unchanged after treatment, and 10 patients (59%) had good outcomes (modified Rankin Scale scores of 1 or 2). CONCLUSION: ICA blister aneurysms can be cautiously explored and treated with direct clipping as the first-line technique in the majority of cases. Complete trapping of the parent artery with temporary clips and placing permanent clip blades along normal arterial walls enables clipping that avoids intraoperative aneurysm rupture. Trapping/bypass is used as the second-line treatment, maintaining a low threshold for bypass with extensive or friable pathology of the carotid wall and in patients with incomplete circles of Willis.

scholarly journals Anatomy of the Middle Cerebral Artery and some related arteries on 256 MSCT

2019 ◽  
Vol 35 (2) ◽  
Author(s):  
Nguyen Tuan Son ◽  
Ngo Xuan Khoa ◽  
Nguyen Quoc Dung ◽  
Dao Dinh Thi
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Anterior Communicating Artery ◽  
Microsurgical Anatomy ◽  
Medical University

Abstracts: Introduction: studying the percentage of display and dimensions of the middle cerebral artery and some related arteries on on  256 MSCT data. Methods: A cross-sectional study, with sample size of 261. Results: The percentage of display of middle cerebral artery is 100%; the posterior artery is 76.4; Internal Carotid Artery is 100%. The average diameter, average length are (mm) M1T respectively: 3.25 ± 0.43 and 19.98 ± 6.10; M1 P: 3.26 ± 0.46 and 19.68 ± 6.28; M2T left 2.10 ± 0.48 and 22.85 ± 13.18; M2T right 2.09 ± 0.49 and 23.42 ± 11.89; M2D left 2.48 ± 0.49 and 31.73-16.36; M2D  right 2.55 ± 0.49 and 29.11 ± 15.31. PCoA T 1.29 ± 0.63 and 11.87 ± 4.87; PCoA P 1.26 ± 0.66 and 14.02 ± 9.13; Conclusions: The size of the middle cerebral artery and some related  arteries were accurately evaluated in the study, the image of vascular anatomy was display clearly. Keywords Middle cerebral artery, cerebral angiography, multi-slices computed tomography ... References [1] H.V. Cúc. To the study of arterial blood supply vessels for Vietnamese adults, Ministry of Health research project, Hanoi Medical University, Hanoi, Vietnam (2000) (in Vietnamese).[2] H.M.Tú. To the study of cerebral artery anatomy on MSCT 64 image, Master's thesis in Medicine, Hanoi Medical University, Hanoi, Vietnam (2011) (in Vietnamese).[3] Ogeng'o, J.A. Geometric features of Vertebrobasilar arterial system in adult Black Kenyans, Int. J. Morphol, 36(2) (2018) 544 - 50. [4] KrzyżewsKi, R.M.. Variation of the anterior communicating artery complex and occurrence of anterior communicating artery aneurysm: A2 segment consideration, Folia medica cracoviensia, LIV (1) (2014) 13 - 20.[5] Jiménez-Sosa, M.S. Anatomical variants of Anterior cerebral arterial circle. A study by Multidetector computerized 3D tomographic angiography, Int J. Morphol 35(3) 1121 – 28.[6] Hamidi, C. (2013). Display with 64-detector MDCT angiography of cerebral vascular variations, Surg Radiol Anat 35 (2017) 729 – 36.[7] Dimmick, S.J., et al. Normal variations of the cerebral circulation at multidetector CT angiography, Radiographics 29(4) (2009) 1027 – 43.[8] P.T.Hà. To the study of Willis polygonal anatomy on MSCT 128 image of patients with cerebral aneurysm, Specialish level 2 thesis in Hanoi Medical University, Hanoi, Vietnam.[9] Saha, A. (2013). Variation of posterior communicating artery in human brain: a morphological study, Gomal Journal of Medical Sciences 11(1) (2018). 42 – 6.[10] Gullari, G. K. The branching pattern of the middle cerebral artery: is the intermediate trunk real or not? An anatomical study correlating with simple angiography, J.Neurosurg, 116 (2012) 1024 - 34.[11] Canaz, H., el al Morphometric analysis of the arteries of Willis Polygon, Romanian Neurosurgery, XXXII (1) (2018) 56 - 64.[12] Pedroza, A. (1987). Microanatomy of the Posterior Communicating Artery, Neurosurgery 20(2) (2018) 229 – 35.[13] Keeranghat, P. P., et al. Evaluation of normal variants of circle of Willis at MRI, Int.J. Res Med Sci, 6(5) (2018) 1617 - 22.[14] Tao, X., Yu, et al. Microsurgical anatomy of the anterior communicating artery complex in adult Chinese heads, Surgical Neurology 65 (2006) 155 – 61.[15] Krejza, J., et al. Carotid artery diameter in Men and Women and the relation to body and neck size, Stroke, 37 (2006) 1103 - 5.[16] Masatoukawashima. Microsurgical anatomy of cerebral revascularization. Part I: Anterior circulation, J.Neurosurg, 102 (2005) 116 – 31.[17] Jeyakumar.R., et al, Study of Anatomical Variations in Middle Cerebral Artery, Int.J.Sci Stud 5(12) (2018) 5-10. [18] Brzegowy, P, et al Middle cerebral artery anatomical variations and aneurysms: a retrospective study based on computed tomography angiography findings, Folia Morphol, 77(3) (2018) 434 – 40.[19] Rohan, V., et al, Length of Occlusion predicts recanalization and outcome after intravenous thrombolysis in middle cerebral artery stroke, Stroke, 45 (2014) 2010 - 17.[20] Vijaywargiya, M., et al. Anatomical study of petrous and cavernous parts of internal carotid artery, Anat Cell Biol, 50 (2017) 163 - 70.[21] Bouthillier, et al Segments of the internal carotid artery: a new classification, Neurosurgery, 38(3), (1996) 425 - 32.  

External Carotid Artery-to-Middle Cerebral Artery Bypass Using a Saphenous Vein Graft With 3-Vessel Anastomosis for the Treatment of a Large, Ruptured Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Kristine Ravina ◽  
Joshua Bakhsheshian ◽  
Joseph N Carey ◽  
Jonathan J Russin
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Saphenous Vein ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Artery Aneurysm ◽  
External Carotid Artery ◽  
External Carotid ◽  
Bifurcation Aneurysm

Abstract Cerebral revascularization is the treatment of choice for select complex intracranial aneurysms unamenable to traditional approaches.1 Complex middle cerebral artery (MCA) bifurcation aneurysms can include the origins of 1 or both M2 branches and may benefit from a revascularization strategy.2,3 A novel 3-vessel anastomosis technique combining side-to-side and end-to-side anastomoses, allowing for bihemispheric anterior cerebral artery revascularization, was recently reported.4  This 2-dimensional operative video presents the case of a 73-yr-old woman who presented as a Hunt-Hess grade 4 subarachnoid hemorrhage due to the rupture of a large right MCA bifurcation aneurysm. The aneurysm incorporated the origins of the frontal and temporal M2 branches and was deemed unfavorable for endovascular treatment. A strategy using a high-flow bypass from the external carotid artery to the MCA with a saphenous vein (SV) graft was planned to revascularize both M2 branches simultaneously, followed by clip-trapping of the aneurysm. Intraoperatively, the back walls of both M2 segments distal to the aneurysm were connected with a standard running suture, and the SV graft was then attached to the side-to-side construct in an end-to-side fashion. Catheter angiograms on postoperative days 1 and 6 demonstrated sustained patency of the anastomosis and good filling through the bypass. The patient's clinical course was complicated by vasospasm-related right MCA territory strokes, resulting in left-sided weakness, which significantly improved upon 3-mo follow-up with no new ischemia.  The patient consented for inclusion in a prospective Institutional Review Board (IRB)-approved database from which this IRB-approved retrospective report was created.

Retromandibular Fossa Approach to the High Cervical Internal Carotid Artery: An Anatomic Study

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS363-ONS370 ◽  
Author(s):  
Yusuf Izci ◽  
Roham Moftakhar ◽  
Mark Pyle ◽  
Mustafa K. Basşkaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Average Length ◽  
Cranial Nerves ◽  
External Carotid Artery ◽  
External Carotid ◽  
Digastric Muscle ◽  
High Cervical ◽  
Cervical Internal Carotid Artery

Abstract Objective: Access to the high cervical internal carotid artery (ICA) is technically challenging for the treatment of lesions in and around this region. The aims of this study were to analyze the efficacy of approaching the high cervical ICA through the retromandibular fossa and to compare preauricular and postauricular incisions. In addition, the relevant neural and vascular structures of this region are demonstrated in cadaveric dissections. Methods: The retromandibular fossa approach was performed in four arterial and venous latex-injected cadaveric heads and necks (eight sides) via preauricular and postauricular incisions. This approach included three steps: 1) sternocleidomastoid muscle dissection; 2) transparotid dissection; and 3) removal of the styloid apparatus and opening of the retromandibular fossa to expose the cervical ICA with the internal jugular vein along with Cranial Nerves X, XI, and XII. Results: The posterior belly of the digastric muscle and the styloid muscles were the main obstacles to reaching the high cervical ICA. The high cervical ICA was successfully exposed through the retromandibular fossa in all specimens. In all specimens, the cervical ICA exhibited an S-shaped curve in the retromandibular fossa. The external carotid artery was located more superficially than the ICA in all specimens. The average length of the ICA in the retromandibular fossa was 6.8 cm. Conclusion: The entire cervical ICA can be exposed via the retromandibular fossa approach without neural and vascular injury by use of meticulous dissection and good anatomic knowledge. Mandibulotomy is not necessary for adequate visualization of the high cervical ICA.

Sign in / Sign up

Export Citation Format

Share Document