scholarly journals Microsurgical clipping of middle cerebral artery aneurysms: complications and risk factors for complications

2021 ◽  
Author(s):  
Thomas METAYER ◽  
Arthur Leclerc ◽  
Alin Borha ◽  
Stephane Derrey ◽  
Olivier Langlois ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Ischemia ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Ruptured Aneurysm ◽  
Safe Procedure ◽  
Neck Size ◽  
Microsurgical Treatment ◽  
Microsurgical Clipping ◽  
Middle Cerebral Artery Aneurysms

Abstract Objective Middle cerebral artery aneurysms (MCAas) with rupture and unruptured IAs are considered good candidates for microsurgery. The objective of the present study was to evaluate the risk of complications and the risk factors for microsurgical treatment of MCAas to better define the indications for microsurgery. Methods We conducted a retrospective cohort study based on data provided from three French tertiary neurosurgical units from January 1, 2013 to May 31, 2020. We first collected data on all the patients who required microsurgical treatment for MCAas. We evaluated the frequency of complications and finally searched for the risk factors for complications after microsurgery. Complications were defined as a composite criterion with the presence of one of the following: procedural-related death, symptomatic cerebral ischemia, impossible exclusion, incomplete exclusion, or (re)bleeding of the treated aneurysm and symptomatic surgical site hematoma. We then compared patients with and without complications using univariate and multivariate analyses. Results Between January 2013 and May 2020, 292 MCAas in 284 patients were treated. A total of 29 (9.9%) MCAas had a complication. The complications were as follows: symptomatic cerebral ischemia: 4.8%, aneurysm rebleeding: 0.3%, surgical site hematoma: 1.0%, impossible exclusion: 0.3%, and incomplete exclusion: 4.1%. However, severe complications, defined as death or a modified Rankin score (mRs) score ≥4 at 3 months, were infrequent and occurred in 7/292 patients (2.4%). In the multivariate analysis, independent risk factors for complications were the following: a ruptured aneurysm, a larger maximum IA size, a larger neck size, and arterial branches passing less than <1 mm from the IA neck or dome. Conclusions MCAa surgery is a safe procedure with a low rate of serious procedure-related complications and an excellent rate of occlusion. The risk factors for complications are a ruptured aneurysm, a larger IA, a larger neck size, and the presence of an “en passage” arterial branch less than 1 mm from the IA. In these cases, at least for factors that do not present a significant difficulty for EVT, such as the presence of an “en passage” artery or ruptured IA, EVT has to be more thoroughly discussed.

scholarly journals Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

2019 ◽  
Vol 130 (3) ◽  
pp. 895-901 ◽  
Author(s):  
Michael A. Mooney ◽  
Elias D. Simon ◽  
Scott Brigeman ◽  
Peter Nakaji ◽  
Joseph M. Zabramski ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Clinical Outcomes ◽  
Cerebral Artery ◽  
Long Term Results ◽  
Ruptured Aneurysm ◽  
Microsurgical Clipping ◽  
Mca Aneurysm

OBJECTIVEA direct comparison of endovascular versus microsurgical treatment of ruptured middle cerebral artery (MCA) aneurysms in randomized trials is lacking. As endovascular treatment strategies continue to evolve, the number of reports of endovascular treatment of these lesions is increasing. Herein, the authors report a detailed post hoc analysis of ruptured MCA aneurysms treated by microsurgical clipping from the Barrow Ruptured Aneurysm Trial (BRAT).METHODSThe cases of patients enrolled in the BRAT who underwent microsurgical clipping for a ruptured MCA aneurysm were reviewed. Characteristics of patients and their clinical outcomes and long-term angiographic results were analyzed.RESULTSFifty patients underwent microsurgical clipping of a ruptured MCA aneurysm in the BRAT, including 21 who crossed over from the endovascular treatment arm. Four patients with nonsaccular (e.g., dissecting, fusiform, or blister) aneurysms were excluded, leaving 46 patients for analysis. Most (n = 32; 70%) patients presented with a Hunt and Hess grade II or III subarachnoid hemorrhage, with a high prevalence of intraparenchymal blood (n = 23; 50%), intraventricular blood (n = 21; 46%), or both. At the last follow-up (up to 6 years after treatment), clinical outcomes were good (modified Rankin Scale score 0–2) in 70% (n = 19) of 27 Hunt and Hess grades I–III patients and in 36% (n = 4) of 11 Hunt and Hess grade IV or V patients. There were no instances of rebleeding after the surgical clipping of aneurysms in this series at the time of last clinical follow-up.CONCLUSIONSMicrosurgical clipping of ruptured MCA aneurysms has several advantages over endovascular treatment, including durability over time. The authors report detailed outcome data of patients with ruptured MCA aneurysms who underwent microsurgical clipping as part of a prospective, randomized trial. These results should be used for comparison with future endovascular and surgical series to ensure that the best results are being achieved for patients with ruptured MCA aneurysms.

One-year Angiographic Results After pCONus Stent-Assisted Coiling of 40 Wide-Neck Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2017 ◽  
Vol 80 (6) ◽  
pp. 925-933 ◽  
Author(s):  
Benjamin Gory ◽  
Marta Aguilar-Pérez ◽  
Elisa Pomero ◽  
Francis Turjman ◽  
Werner Weber ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Coiling ◽  
Total Occlusion ◽  
Complete Occlusion ◽  
Neck Size ◽  
Clinical Complications ◽  
Middle Cerebral Artery Aneurysms ◽  
Wide Neck

Abstract BACKGROUND: Bifurcation middle cerebral artery (MCA) aneurysms with wide neck are amenable to endovascular coiling with pCONus stent, a recent device dedicated to wide-neck bifurcation intracranial aneurysms. OBJECTIVE: To evaluate the 1-year angiographic follow-up of wide-neck MCA aneurysms treated with pCONus. METHODS: Forty MCA aneurysms (mean dome size, 7.7 mm; mean neck size, 5.6 mm) coiled with pCONus were retrospectively evaluated. “Recanalization” was defined as worsening, and “progressive thrombosis” was defined as improvement on the Raymond scale. RESULTS: Angiographic midterm (mean, 11.9 months; range, 3-20) follow-up was obtained in all aneurysms. Retreatment was performed in 9 aneurysms (22.5%) without clinical complications, and postoperative angiographic outcome included 2 complete occlusions and 7 neck remnants. Six aneurysms were followed after retreatment (mean, 8.8 months), and presented complete occlusion in 1 case, neck remnant in 4 cases, and aneurysm remnant in 1 case. Among the 31 aneurysms, follow-up showed complete occlusion in 67.7% (21/31), neck remnants in 29% (9/31), and aneurysm remnants in 3.3% (1/31). Adequate aneurysm occlusion (total occlusion and neck remnant) was obtained in 96.7% (30/31). Among these 31 aneurysms, improvement of the rate of occlusion was observed in 15 aneurysms (48.4%), and recurrence in 2 aneurysms (6.5%). There was no 1-year angiographic recurrence of 3- or 6-month totally occluded aneurysms. CONCLUSION: pCONus stent allows a safe coiling of wide-neck MCA aneurysms usually considered as surgical with a low recanalization rate for those adequately occluded at 3 to 6 months. Angiographic results improve over time due to progressive aneurysm thrombosis in around 50% of cases.

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 &lt; 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 &lt; 60 years of age with an aneurysm &gt; 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 &gt; 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.

Microsurgical Clipping and Bypass for Fusiform Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Nickalus R Khan ◽  
Stephanie H Chen ◽  
Jacques J Morcos
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Superficial Temporal Artery ◽  
Artery Aneurysm ◽  
Patient Discharge ◽  
Temporal Artery ◽  
Surgical Anatomy ◽  
Microsurgical Treatment ◽  
Microsurgical Clipping

Abstract Fusiform middle cerebral artery (MCA) aneurysms that require treatment can often necessitate complex endovascular or microsurgical treatment. We present a case of a 25-yr-old female with an incidentally discovered left 14-mm fusiform MCA aneurysm incorporating the frontal MCA trunk origin in its dome. The location and anatomy were not favorable for endovascular treatment with flow diversion.  The patient was offered continued observation or microsurgical treatment. Direct clipping of this aneurysm was not possible. After a thorough discussion of the risks, benefits, indications, and natural history of the lesion, the patient desired to have the aneurysm treated given her young age, location, size of the aneurysm, and the significant clinical experience of the treating team in bypass surgery.  The patient underwent superficial temporal artery to frontal M2 (STA-FM2) direct bypass for flow replacement followed by microsurgical trapping and clip ligation. The patient was maintained on antiplatelet therapy preoperatively and postoperatively. The patient had a transient aphasia and mild right upper extremity weakness (4/5) in the immediate postoperative period, which fully recovered by the time of patient discharge. The case presentation, surgical anatomy, technique, and postoperative course and outcome are reviewed. The different strategies for bypass and clip ligation are reviewed with particular focus on the anatomic constraints for each bypass configuration. The outcomes of bypass surgery for MCA aneurysms are reviewed.1-7 The patient gave verbal consent for participating in the procedure, surgical video, and publication of their image.

Treatment of Large and Giant Middle Cerebral Artery Aneurysms: Risk Factors for Unfavorable Outcomes

2017 ◽  
Vol 102 ◽  
pp. 301-312 ◽  
Author(s):  
Wonhyoung Park ◽  
Jaewoo Chung ◽  
Jae Sung Ahn ◽  
Jung Cheol Park ◽  
Byung Duk Kwun
Keyword(s):  
Risk Factors ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Middle Cerebral Artery Aneurysms
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