scholarly journals Single fronto-temporal sylvian vein reconstruction when treating a large partially thrombosed aneurysm of the M1 middle cerebral artery

2016 ◽  
Vol 20 (3) ◽  
pp. 118
Author(s):  
A V Dubovoy ◽  
K S Ovsyannikov ◽  
M E Amelin
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Conflict Of Interest ◽  
Clinical Case ◽  
Sylvian Fissure ◽  
Aneurysm Neck ◽  
Temporal Lobes ◽  
Transsylvian Approach ◽  
Thrombosed Aneurysm ◽  
End To End

<p>The article describes a clinical case of clipping the neck of large partially thrombosed aneurysm by using a transsylvian approach. A feature of the case is an atypical structure of the Sylvian fissure, with just one vein draining both the frontal and the temporal lobes and hindering access to the Sylvian fissure. The problem was solved by cutting the vein, performing the aneurysm neck clipping and suturing the cut vein by means of end-to-end technique. </p><p>Received 19 April 2016. Accepted 7 September 2016.</p><p><strong>Funding:</strong> The study had no sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p>

scholarly journals Trapping, dome puncture, and direct suction decompression in conjunction with assistant superficial temporal artery- middle cerebral artery bypass to clip giant internal carotid artery bifurcation aneurysm

2019 ◽  
Vol 10 ◽  
pp. 205
Author(s):  
Seiei Torazawa ◽  
Hideaki Ono ◽  
Tomohiro Inoue ◽  
Takeo Tanishima ◽  
Akira Tamura ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Optimal Treatment ◽  
Aneurysm Neck ◽  
Bifurcation Aneurysm

Background: Very large and giant aneurysms (≥20 mm) of the internal carotid artery (ICA) bifurcation (ICAbif) are definitely rare, and optimal treatment is not established. Endovascular treatments are reported as suboptimal due to difficulties of complete occlusion and tendencies to recanalization. Therefore, direct surgery remains an effective strategy if the clipping can be performed safely and reliably, although very difficult. Case Description: Two cases of ICAbif aneurysms (>20 mm) were treated. Prior assistant superficial temporal artery (STA)-middle cerebral artery (MCA) bypass was performed to avoid ischemic complications during prolonged temporary occlusion of the arteries in both cases. In Case 1 (22-mm aneurysm), the dome was inadvertently torn in applying the clip because trapping had resulted in insufficient decompression. Therefore, in Case 2 (28-mm aneurysm), almost complete trapping of the aneurysm and subsequent dome puncture was performed, and the aneurysm was totally deflated by suction from the incision. This complete aneurysm decompression allowed safe dissection and successful clipping. Conclusion: Trapping, deliberate aneurysm dome puncture, and suction decompression from the incision in conjunction with assistant STA-MCA bypass can achieve complete aneurysm deflation, and these techniques enable safe dissection of the aneurysm and direct clipping of the aneurysm neck. Direct clipping with this technique for very large and giant ICAbif aneurysms may be the optimal treatment choice with the acceptable outcome if endovascular treatment remains suboptimal.

scholarly journals The hyperdense sylvian fissure MCA ”dot“ sign: a marker of acute CT ischemia

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 346-346
Author(s):  
Philip A Barber ◽  
Andrew M Demchuk ◽  
Mark E Hudon ◽  
Warwick Pexman ◽  
Michael D Hill ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Symptom Onset ◽  
Clinical Information ◽  
Diagnostic Value ◽  
Sylvian Fissure ◽  
Ct Scans ◽  
Kappa Statistics ◽  
Computed Tomographic ◽  
Good Range

P40 Background: The hyperdense appearance of the middle cerebral artery is now a familiar early warning of large cerebral infarction, brain oedema and poor prognosis. Less well described, however, is the hyperdensity associated with embolic occlusion of branches of the middle cerebral artery seen in the sylvian fissure (MCA ”dot“ sign). The aim of this study was to define this sign, and to determine the incidence, its diagnostic value, and reliability. Methods: Computed tomographic (CT) scans performed on patients with acute ischemic stroke within 3 hours of symptom onset were analysed for signs of thromboembolic stroke and evidence of early CT ischemia. Two neuroradiologists and two stroke neurologists initially blinded to all clinical information, and then with knowledge of the affected hemisphere evaluated scans for the presence of a hyperdense MCA sign (HMCA), a hyperdense sylvian fissure MCA ”dot“ sign, and for early MCA territory ischemic changes. Results: Of 100 consecutive patients presenting within 3 hours of symptom onset early CT ischemia was seen in 74 % of the baseline CT scans. The HMCA sign was seen in 5% of CT scans whereas the MCA ”dot“ sign was seen in 16% of which 2 were associated with a HMCA sign. The presence of a HMCA sign was associated with a greater probability of dependence or death than when a MCA ”dot“ sign was observed or no hyperdensity was seen (P<0.05). All 5 patients with a HMCA sign, including 2 with an associated MCA ”dot“ sign were either dead or dependent at 3 months. Patients with a dot sign alone had independent outcomes in 64% of cases (P<0.8). Balanced kappa statistics for both signs were in the moderate to good range when the side of stroke was known. Conclusions: The hyperdense sylvian fissure MCA ”dot“ sign is an early marker of thromboembolic occlusion of the distal MCA and of its branches.

Temporal Lobe Syndromes

2020 ◽  
pp. 122-135
Author(s):  
Arpit Parmar ◽  
G. S. Kaloiya ◽  
Harsimarpreet Kaur
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebral Cortex ◽  
Brain Injury ◽  
Middle Cerebral Artery ◽  
Temporal Lobe ◽  
Cerebral Artery ◽  
Left Temporal Lobe ◽  
Temporal Lobes ◽  
Functional Aspects ◽  
The Common

Temporal lobes are one of the four major lobes of the cerebral cortex and perform a complex array of interrelated functions. They play an important role in various day-to-day functioning. The common pathologies leading to isolated temporal lobe dysfunction are infarction (of the middle cerebral artery), hemorrhage, seizures, tumors, encephalitis, and traumatic brain injury. Temporal lobe syndromes include a wide array of various neurological (Kluver-Bucy syndrome, Geschwind Gastaut syndrome, etc.), elementary (e.g., vertiginous syndromes, hallucinations, etc.), neuropsychiatric (e.g., anxiety, agitation, aggression, etc.), and cognitive (e.g., Korsakoff amnesia, cortical deafness, etc.) disorders. The presentation depends on a multitude of factors including involvement of dominant or non-dominant lobe. Left temporal lobe involvement usually leads to various forms of aphasia while right side involvement leads to more covert and varied syndromes. In this chapter, the authors discuss the anatomy of the temporal lobe, its functional aspects, and various syndromes of temporal lobe dysfunction.

Transorbital endoscopic approach for exposure of the sylvian fissure, middle cerebral artery and crural cistern: an anatomical study

2017 ◽  
Vol 159 (10) ◽  
pp. 1893-1907 ◽  
Author(s):  
João Paulo Almeida ◽  
Armando S. Ruiz-Treviño ◽  
Sathwik R. Shetty ◽  
Sacit B. Omay ◽  
Vijay K. Anand ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Anatomical Study ◽  
Sylvian Fissure ◽  
Endoscopic Approach

Microsurgical Management of Large, Fusiform, Partially Thrombosed Middle Cerebral Artery (M2) Aneurysm with End-to-End M2 Anastomosis: 3-Dimensional Operative Video

2017 ◽  
Vol 13 (4) ◽  
pp. 535-535 ◽  
Author(s):  
Harminder Singh ◽  
Harley Brito da Silva ◽  
David C. Straus ◽  
Mehdi Zeinalizadeh ◽  
Laligam N. Sekhar
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
3 Dimensional ◽  
End To End

Abstract

scholarly journals Clip reconstruction of a large right MCA bifurcation aneurysm. Case report

2014 ◽  
Vol 21 (2) ◽  
pp. 163-167
Author(s):  
A. Giovani ◽  
Angela Neacsu ◽  
Ana Gheorghiu ◽  
R.M. Gorgan
Keyword(s):  
Case Report ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Neurological Deficit ◽  
Sylvian Fissure ◽  
Pterional Craniotomy ◽  
Bifurcation Aneurysm ◽  
Temporary Clip

Abstract We report a case of complex large middle cerebral artery (MCA) bifurcation aneurysm that ruptured during dissection from the very adherent MCA branches but was successfully clipped and the MCA bifurcation reconstructed using 4 Yasargill clips. Through a right pterional craniotomy the sylvian fissure was largely opened as to allow enough workspace for clipping the aneurysm and placing a temporary clip on M1. The pacient recovered very well after surgery and was discharged after 1 week with no neurological deficit. Complex MCA bifurcation aneurysms can be safely reconstructed using regular clips, without the need of using fenestrated clips or complex by-pass procedures.

scholarly journals Two Indices Affecting the Directions of the Sylvian Fissure Dissection in Middle Cerebral Artery Bifurcation Aneurysms

2013 ◽  
Vol 15 (3) ◽  
pp. 164 ◽  
Author(s):  
Hyun Wook Park ◽  
Seung Young Chung ◽  
Moon Sun Park ◽  
Seong Min Kim ◽  
Byul Hee Yoon ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Sylvian Fissure ◽  
Two Indices

scholarly journals Orbitozygomatic Craniotomy for Clipping a Complex Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (2) ◽  
pp. E33-E33
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Video Recording ◽  
Artery Aneurysm ◽  
Sylvian Fissure ◽  
Parent Artery ◽  
Parent Vessel ◽  
Institutional Review ◽  
Vessel Patency ◽  
Mca Aneurysm

Abstract Middle cerebral artery (MCA) aneurysms pose a surgical challenge because of the large caliber of the parent artery and the common need to dissect the sylvian fissure to permit access to the proximal and distal control. The neck of the aneurysm should be generously dissected to permit visualization of any adjacent lenticulostriate perforators. This patient demonstrated a left-sided wide-necked bilobed MCA aneurysm at the M1 bifurcation. The aneurysm was approached using a left orbitozygomatic craniotomy with distal sylvian fissure dissection. A single curved clip was applied for aneurysm occlusion, and postoperative angiography demonstrated aneurysm obliteration with parent vessel patency. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Clipping and STA-MCA bypass for unruptured AcomA aneurysm associated with unilateral MCA occlusion

2015 ◽  
Vol 38 (videosuppl1) ◽  
pp. Video2 ◽  
Author(s):  
Tomohiro Inoue ◽  
Hiroki Yoshida ◽  
Akira Tamura ◽  
Isamu Saito
Keyword(s):  
Surgical Technique ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Sylvian Fissure ◽  
Anterior Communicating Artery ◽  
Mca Occlusion ◽  
Interhemispheric Fissure ◽  
Good Exposure

The authors show a surgical technique of clipping in conjunction with superficial temporal artery (STA)–middle cerebral artery (MCA) bypass to treat unruptured anterior communicating artery (AcomA) aneurysm associated with unilateral MCA occlusion. First, through MCA occlusion side, fronto-temporal craniotomy, extra-dural drilling of lesser sphenoid wing, and followed by wide exposure of Sylvian fissure, STA–MCA bypass was performed. Then, through trans-Sylvian, fronto-basal, and lateral trajectory, interhemispheric fissure was dissected from the base, which enabled good exposure and clipping of high positioned AcomA aneurysm.The video can be found here: http://youtu.be/GWItnRSs3m4.

Microsurgical and Angiographic Anatomy of Middle Cerebral Artery Aneurysms: Prevalence and Significance of Early Branch Aneurysms

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS344-ONS353 ◽  
Author(s):  
Arthur J. Ulm ◽  
Gregory L. Fautheree ◽  
Necmettin Tanriover ◽  
Antonino Russo ◽  
Erminia Albanese ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Retrospective Review ◽  
Intracerebral Hematoma ◽  
Aneurysm Neck ◽  
Average Patient ◽  
Ischemic Complications ◽  
Middle Cerebral Artery Aneurysms ◽  
Frontal Branch

Abstract Objective: To determine the prevalence of early branch aneurysms, characterize these lesions angiographically and anatomically, and determine their clinical significance. Methods: The authors conducted a retrospective review of 125 consecutive patients with a diagnosis of middle cerebral artery (MCA) aneurysm. Eighty-four patients harboring 100 MCA aneurysms were studied; 41 patients were excluded for lack of adequate imaging or for fusiform morphology of the aneurysm. Demographic characteristics including age, side, sex, subarachnoid hemorrhage, intracerebral hematoma, multiple aneurysms, and type of treatment were obtained. Results: The average patient age was 57.3 years (range, 29–79 yr); 69 were women and 15 were men. Fifty-eight were right MCA aneurysms and 42 were left aneurysms. Fourteen patients had multiple MCA aneurysms. Thirty-nine of 100 aneurysms were associated with subarachnoid hemorrhage. Twelve of 100 aneurysms were associated with an intracerebral hematoma. The average aneurysm sizes were 9.1 mm overall (range, 2.0–27.0 mm), 12.3 mm for ruptured aneurysms, and 7.5 mm for unruptured. There were 36 M1 bifurcation aneurysms, 39 early frontal branch aneurysms, 18 early temporal branch aneurysms, four lenticulostriate artery aneurysms, and three trifurcation aneurysms. Conclusion: In our retrospective review, the majority of MCA aneurysms arose along the M1 segment proximal to the M1 bifurcation. Early frontal branch aneurysms were more common than typical M1 segment bifurcation aneurysms. M1 segment aneurysms arising from early frontal and early temporal branches have distinct anatomic features that impact surgical management and outcome. Understanding the relationship between the recurrent lenticulostriate arteries arising from the proximal segments of these early branches and the aneurysm neck should allow surgeons to avoid many postoperative ischemic complications when dealing with these challenging lesions.

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