scholarly journals Rare case of a ruptured distal middle cerebral artery fusiform aneurysm: a neurosurgical challenge.

2018 ◽  
Vol 5 (2) ◽  
pp. 3550-3552
Author(s):  
Jagminder Singh ◽  
Amit Mittal ◽  
Rakesh Kumar Kaushal ◽  
Rupinder Kaur ◽  
Simran Kaur ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Surgical Intervention ◽  
Computed Tomographic Angiography ◽  
Fusiform Aneurysm ◽  
Computed Tomographic ◽  
Tomographic Angiography ◽  
Middle Cerebral Artery Aneurysms ◽  
Distal Middle Cerebral Artery ◽  
Early Surgical Intervention

Distal ruptured fusiform middle cerebral artery (MCA) M4 segment aneurysms are rare and their management is a challenge to the neurosurgeon. Fusiform aneurysm of M4 part of is even rarer. Patient usually presents with headache or neurological deficit. Computed tomographic angiography helps to confirm diagnosis. Treatment involves micro-neurosurgical clipping or trapping and excision of aneurysm. Early surgical intervention of distal middle cerebral artery aneurysms favours better outcome. We report a case of 20 year old female patient who presented with complaint of severe headache. Neuroimaging was suggestive of right M4 middle cerebral artery fusiform aneurysm with intracerebral haemorrhage. Patient was managed by trapping and excision of aneurysm and recovered well. 

scholarly journals Collateral status evaluation coupled with time window by dynamic axial computed tomographic angiography with a focus on the middle cerebral artery for mechanical thrombectomy

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takahisa Mori ◽  
Kazuhiro Yoshioka ◽  
Wataru Mori ◽  
Yuhei Tanno
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Time Window ◽  
Computed Tomographic Angiography ◽  
Ct Scanner ◽  
Computed Tomographic ◽  
Upper Limit ◽  
Mca Occlusion ◽  
Tomographic Angiography

Abstract Background Dynamic axial computed tomographic angiography (dynax–CTA), covering a thin width, with a focus on the bilateral middle cerebral artery (MCA), can quickly visualize the internal carotid artery (ICA) or MCA occlusion. We aimed to investigate whether dynax–CTA appropriately evaluated the collateral status coupled with the upper limit of the onset-to-reperfusion (OtR) time to achieve a major neurological improvement (MNI) at a 24-h follow-up examination after mechanical thrombectomy (MT). Methods We included acute ischemic stroke patients admitted from 2018 to 2020 who underwent dynax–CTA on admission and emergent MT for ICA or MCA occlusion. We performed dynax–CTA using an 80-row CT scanner and acquired 25 volume scans, consisting of 40 images of 1-mm thickness and 4-cm width. We classified the collateral status as good, intermediate, and poor based on MCA branch opacification. We evaluated the collateral status and the upper OtR time limit to achieve MNI. Results Forty-eight patients met our inclusion criteria. Dynax–CTA findings demonstrated MCA and ICA occlusion in 30 and 18 patients, respectively. The collateral status was good, intermediate, and poor in four, 25, and 19 patients, respectively. The upper limits of the OtR time for MNI were 3.63, 8.08, and 8.67 h in patients with poor, intermediate, and intermediate or good collateral status, respectively. Conclusions Dynax–CTA appropriately evaluated the collateral status coupled with the upper limit of the OtR time before performing MT.

A New, More Accurate Classification of Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2013 ◽  
Vol 73 (1) ◽  
pp. 94-102 ◽  
Author(s):  
Ahmed Elsharkawy ◽  
Martin Lehečka ◽  
Mika Niemelä ◽  
Romain Billon-Grand ◽  
Hanna Lehto ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Computed Tomographic Angiography ◽  
Group Classification ◽  
Intracerebral Hematoma ◽  
Computed Tomographic ◽  
Common Location ◽  
Lenticulostriate Artery ◽  
Tomographic Angiography

Abstract BACKGROUND: Classification of middle cerebral artery (MCA) aneurysms is sometimes difficult because the identification of the main MCA bifurcation, the key for accurate classification of MCA aneurysms, is inconsistent and somewhat subjective. OBJECTIVE: To use the meeting point of the M1 and M2 trunks as an objective, generally accepted, and angiographically evident hallmark for identification of MCA bifurcation and more accurate classification of MCA aneurysms. METHODS: We reviewed the computed tomographic angiography data of 1009 consecutive patients with 1309 MCA aneurysms. The M2 trunks were followed proximally until their meeting with the M1 trunk at the main MCA bifurcation. The aneurysms were classified according to their relative location: proximal, at, or distal to the MCA bifurcation. The M1 aneurysms were further subgrouped into M1 early cortical branch aneurysms and M1 lenticulostriate artery aneurysms, extending the classic 3-group classification of MCA aneurysms into a 4-group classification. RESULTS: The main MCA bifurcation was the most common location for MCA aneurysms, harboring 829 aneurysms (63%). The 406 M1 aneurysms comprised 242 M1 early cortical branch aneurysms (60%) and 164 M1 lenticulostriate artery aneurysms (40%). We found 106 MCA aneurysms (8%) at the origin of large early frontal branches simulating M2 trunks liable to be misclassified as MCA bifurcation aneurysms. Even though 51% of the 407 ruptured MCA aneurysms were associated with an intracerebral hematoma, this did not affect the classification. CONCLUSION: Studying MCA angioarchitecture and applying the 4-group classification of MCA aneurysms is practical and facilitates the accurate classification of MCA aneurysms, helping to improve surgical outcome.

Microneurosurgical management of distal middle cerebral artery aneurysms

2007 ◽  
Vol 67 (6) ◽  
pp. 553-563 ◽  
Author(s):  
Reza Dashti ◽  
Juha Hernesniemi ◽  
Mika Niemelä ◽  
Jaakko Rinne ◽  
Martin Lehecka ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Middle Cerebral Artery Aneurysms ◽  
Distal Middle Cerebral Artery

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.

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