Angiographic Morphological Characteristics of Middle Cerebral Artery aneurysms

Background: The treatment of Middle Cerebral Artery Aneurysms (MCAA) and the relation of their morphology to the chance of rupture are an important topic in vascular neurosurgery. Objective: To assess the correlation between MCAA morphology and 1) the chance of aneurysm rupture and 2) its morbimortality. Methods: Twenty-nine patients with MCAA at the M1 segment (4 patients had multiple aneurysms), were followed/ treated by our crew at a single institution over the last 5 years; 14 aneurysms were ruptured at the time of admission and 15 were diagnosed incidentally. Aneurysms were classified by shape and their geometries were correlated with rupture rate and their morbimortality. Results: Aneurysms measured between 7 and 10 mm in diameter (90% of the aneurysms), and there was no difference in size between the ruptured and unruptured aneurysms. Patients whose MCAAs were ruptured at admission were 3 times as likely than patients with unruptured aneurysms to have a transverse elliptic or inverted-pear-shaped aneurysm (21% vs 9%, p<0.05). On the other hand, patients with unruptured MCAAs were 6 times more likely than patients with ruptured MCAAs to have a pear-shaped aneurysm (36.3% vs 5.2%, p<0.001). Round-shaped aneurysms were more frequent overall, but they were not significantly more prone to rupture. Conclusion: Although this was a small group of patients, we conclude that transverse elliptic and inverted-pear-shaped aneurysms were more associated with rupture than round/ pear-shaped aneurysms.

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Coil Embolization of Unruptured Middle Cerebral Artery Aneurysms

Neurosurgery ◽

10.1227/neu.0b013e3182035fdc ◽

2011 ◽

Vol 68 (2) ◽

pp. 346-354 ◽

Cited By ~ 33

Author(s):

Byung Moon Kim ◽

Dong Ik Kim ◽

Sung Il Park ◽

Dong Joon Kim ◽

Sang Hyun Suh ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Primary Treatment ◽

Aneurysm Rupture ◽

Endovascular Coiling ◽

Unruptured Aneurysms ◽

Permanent Morbidity ◽

Middle Cerebral Artery Aneurysms

Abstract BACKGROUND: Since the International Subarachnoid Aneurysmal Trial, endovascular coiling has been increasingly used as primary treatment option for ruptured or unruptured aneurysms that are feasible for coiling. OBJECTIVE: To evaluate the feasibility and clinical and angiographic outcomes of coiling for unruptured middle cerebral artery aneurysms. METHODS: The records of 70 consecutive patients with 76 unruptured middle cerebral artery aneurysms who underwent coiling were retrospectively evaluated. RESULTS: Thirty-one aneurysms were treated by single-catheter, 18 by multicatheter, 11 by balloon-assisted, 13 by stent-assisted, and 3 by a combination of multicatheter and balloon-assisted techniques. Coiling was accomplished in 75 but failed in 1 aneurysm. One patient died of consequences of subarachnoid hemorrhage occurring 9 hours after coiling. One intraprocedural aneurysm rupture occurred, which was controlled by further coil insertions and left no sequelae. There were 1 cortical infarction and 1 basal ganglia infarction, both of which recovered completely. Treatment-related permanent morbidity and mortality rates were 0% and 1.4%, respectively. Postembolization control angiography revealed 40 complete, 30 neck remnant, and 5 incomplete occlusions. Clinical follow-up was available in all patients (mean, 25 months; range, 7-105 months). There was no subarachnoid hemorrhage during follow-up, but 1 death resulting from acute myocardial infarction occurred 3 months after coiling. None of the surviving patients had any neurological deterioration. Follow-up angiography was available in 69 aneurysms at 6 to 24 months (mean, 12 months). Three major and 6 minor recurrences were detected. All 3 major recurrent aneurysms were re-treated by coiling without any complications. CONCLUSION: Most unruptured middle cerebral artery aneurysms could be safely treated by coiling with acceptable short-term to midterm outcomes. Our results warrant further study with a longer follow-up period in a larger population.

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Flow diverter device for the treatment of small middle cerebral artery aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011460 ◽

2015 ◽

Vol 8 (3) ◽

pp. 287-294 ◽

Cited By ~ 49

Author(s):

Francesco Briganti ◽

Luigi Delehaye ◽

Giuseppe Leone ◽

Carmine Sicignano ◽

Giuseppe Buono ◽

...

Keyword(s):

Endovascular Treatment ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Flow Diverter ◽

Aneurysm Rupture ◽

Side Branch ◽

Neurological Deficits ◽

Complete Occlusion ◽

Ischemic Complications ◽

Middle Cerebral Artery Aneurysms

PurposeExperience with the endovascular treatment of middle cerebral artery (MCA) aneurysms by flow diverter devices (FDD) is still limited. This study examines the results and complications of FDD for small aneurysms at this location.MethodsFrom February 2010 to December 2013, 14 patients (10 women; mean age 59 years) with 15 small MCA aneurysms were treated with FDD. All procedures were performed with the Pipeline embolization device (PED).ResultsComplete occlusion was obtained in 12/15 aneurysms (80%) and partial occlusion in 3 (20%). Among 13 aneurysms with a side branch, this was patent at the angiographic control in 4 cases, showed decreased filling in 6, and was occluded in 3 (with neurological deficits in 2). All PEDs were patent at follow-up. Post-procedural ischemic complications occurred in 4 (27%) procedures with permanent neurological deficit (modified Rankin score 2) in 3 (21%). No early or delayed aneurysm rupture, no subarachnoid or intraparenchymal hemorrhage and no deaths occurred.ConclusionsEndovascular treatment with FDD is a relatively safe treatment for small MCA aneurysms resulting in a high occlusion rate. The findings of this study suggest that complete occlusion after endovascular treatment with FDD can be delayed (>6 months). Ischemic complications may occur as early or delayed, particularly at clopidogrel interruption.

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Morphology of Middle Cerebral Artery Aneurysms: Impact on Surgical Strategy and on Postoperative Outcome

ISRN Stroke ◽

10.1155/2013/838292 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Karl-Michael Schebesch ◽

Martin Proescholdt ◽

Kathrin Steib ◽

Odo-Winfried Ullrich ◽

Andreas Herbst ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Morphological Characteristics ◽

Postoperative Outcome ◽

Irregular Shape ◽

Maximum Diameter ◽

Parent Artery ◽

Risk Of Rupture ◽

Middle Cerebral Artery Aneurysms ◽

Intraoperative Rupture

The outcome of middle cerebral artery (MCA) aneurysm clipping depends on the presence of subarachnoid hemorrhage (SAH). Moreover, it is influenced by anatomical features of the aneurysm and its parent artery. We hypothesized that morphological characteristics of the aneurysm may be predictive for postoperative outcome. Therefore, we identified radiographic assessable details that predicted the surgical difficulty and the risk for new ischemia. The angiograms of 151 consecutive patients (82 presenting with SAH) were analyzed in a standardized fashion focusing on 12 defined morphological aspects. The results were correlated to intraoperative rupture and to postoperative ischemia. Aneurysms presenting with SAH were associated with irregular shape, larger maximum diameter, and larger dome-to-base distance (DBD) and were located more frequently on the M2 segment. Multivariate analysis revealed 6 independent predictors for intraoperative rupture: SAH, location on M2 segment, DBD, maximum diameter, diameter of the parent MCA, and the presence of branching vessel. Independent predictors of surgery-related ischemia were identified: SAH, irregular shape, location on M2 segment, DBD, and the neck-to-vessel ratio (NVR). In MCA aneurysms, independent predictors for the risk of rupture intraoperatively and for the postsurgical outcome were the presence of SAH, location on the M2-segment, size (DBD), and the broadness of the neck.

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A Shift from Open to Endovascular Repair of Ruptured Middle Cerebral Artery Aneurysms and its Association with Improved 6-month Clinical Outcomes: Single Institution Experience

10.26226/morressier.5e8335ba7cb08a046ef7c78b ◽

2020 ◽

Author(s):

Aditya Bharatha

Keyword(s):

Middle Cerebral Artery ◽

Clinical Outcomes ◽

Cerebral Artery ◽

Endovascular Repair ◽

Single Institution ◽

Middle Cerebral Artery Aneurysms

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Feasibility and safety of partial resection of the anterior insular cortex for microsurgical treatment of middle cerebral artery aneurysms located in the limen recess: patient series

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21158 ◽

2021 ◽

Vol 1 (23) ◽

Author(s):

Yosuke Akamatsu ◽

Hiroshi Kashimura ◽

Shunrou Fujiwara ◽

Yoshitaka Kubo ◽

Kuniaki Ogasawara

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Insular Cortex ◽

Partial Resection ◽

Unruptured Aneurysms ◽

Clip Application ◽

Ischemic Complications ◽

Patient Series ◽

Middle Cerebral Artery Aneurysms

BACKGROUND When performing clip ligation of superior projecting aneurysms of the proximal (M1) segment of the middle cerebral artery (MCA), meticulous sylvian fissure dissection alone may be inadequate for safe clip application, especially in cases in which the aneurysm is buried in the limen recess, since the limen insulae may be positioned lateral to the aneurysm. In the present patient series, the authors present their surgical technique for clip ligation of aneurysms located in the limen recess, with partial resection of the limen insulae. OBSERVATIONS A retrospective analysis of patients who had undergone clip ligation of MCA aneurysms located at the limen recess at a single institute was performed. Patients with angiographic and clinical follow-up data were considered eligible. A total of 11 aneurysms (4 ruptured and 7 unruptured aneurysms) in 11 patients were evaluated. Postoperative ischemic lesions were observed on images obtained within 1 week after surgery in 5 (45.5%) patients who had undergone partial resection of the limen insulae, although none of them presented with neurological deterioration. LESSONS Partial resection of limen insulae may be feasible to avoid severe ischemic complications following clip ligation of M1 aneurysms embedded in the limen recess.

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MORPHOLOGICAL DIFFERENCES BETWEEN RUPTURED AND UNRUPTURED CASES IN MIDDLE CEREBRAL ARTERY ANEURYSMS

Neurosurgery ◽

10.1227/01.neu.0000311347.35583.0c ◽

2008 ◽

Vol 62 (3) ◽

pp. 602-609 ◽

Cited By ~ 42

Author(s):

Takashi Sadatomo ◽

Kiyoshi Yuki ◽

Keisuke Migita ◽

Eiji Taniguchi ◽

Yasunori Kodama ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Three Dimensional ◽

Artery Aneurysm ◽

Parent Artery ◽

Unruptured Aneurysms ◽

Type D ◽

Type C ◽

Morphological Differences ◽

Middle Cerebral Artery Aneurysms

Abstract OBJECTIVE To elucidate the morphological differences between ruptured and unruptured aneurysms, three-dimensional digital subtraction angiography was performed in 44 cases (20 unruptured, 24 ruptured) of middle cerebral artery aneurysm. METHODS When the neck was located on the extension of the midline of the parent artery, it was defined as Type C; when it was not, it was defined as Type D. Aspect ratio (AP ratio; dome/neck ratio) and daughter artery ratio (DA ratio; diameter of the larger daughter artery/diameter of the smaller daughter artery) were calculated, and these ratios were compared for ruptured and unruptured cases. RESULTS Nineteen cases were Type C and 25 cases were Type D. χ2 test revealed that there were significantly more ruptured cases among Type C (14 out of 19) compared with Type D (10 out of 25) (P < 0.05). AP ratios were 2.24 ± 0.75 for ruptured cases and 1.56 ± 0.58 for unruptured cases. DA ratios were 1.53 ± 0.54 in ruptured cases and 2.14 ± 0.80 for unruptured cases. Both showed significant differences (P < 0.01). In cases with an AP ratio of 1.8 or greater and a DA ratio less than 1.7, 13 out of 15 (87%) were ruptured cases. On the contrary, in cases with an AP ratio less than 1.8 and a DA ratio of 1.7 or greater, 12 out of 13 (92%) were unruptured cases. CONCLUSION Type C and equality of the diameters of two daughter arteries, together with high AP ratios, seem to be morphological factors that associate with aneurysmal rupture.

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Prognostic factors of ruptured middle cerebral artery aneurysms treated with surgical clipping

Romanian Neurosurgery ◽

10.33962/roneuro-2020-037 ◽

2020 ◽

pp. 245-253

Author(s):

Samer S. Hoz ◽

Saja A. Albanaa ◽

Ali M. Neamah ◽

Farah W. Abdulmohsin ◽

Zahraa Al-Sharshahi

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Artery Aneurysm ◽

Middle Cerebral Artery Aneurysm ◽

Surgical Clipping ◽

Unruptured Aneurysms ◽

Surgical Data ◽

Middle Cerebral Artery Aneurysms ◽

Cerebral Artery Aneurysm ◽

The Relationship

Background: Spontaneous subarachnoid haemorrhage is an emergent condition that leads to profound morbidity and mortality. It is mainly caused by a ruptured intracranial aneurysm. Herein we described the relationship of different factors and their impact on the outcome of patients who underwent a surgical clipping exclusively to the ruptured middle cerebral artery aneurysm. Methods: We retrospectively analyzed the medical records of patients admitted to the Neurosurgery Teaching Hospital (NTH) in Baghdad for the period between January 2017-April 2019 of patients who underwent microsurgical clipping for ruptured middle cerebral artery aneurysm. Demographic, clinical, radiological and surgical data were extracted. A univariate analysis was used to illustrate the relationship between the variables and outcome which was assessed using the five scores of the Glasgow Outcome Scale where patients were dichotomized into two groups; favourable (IV + V) and unfavourable (I, II, III). Results: Within this cohort, a total of 50 patients were studied and the analysis revealed that 92% (N=46) had a favourable outcome and 8% (N=4) had an unfavourable outcome at discharge. The in-hospital mortality was 6%(N=3). Factors that were significantly associated with poor outcome were giant aneurysms, the presence of other unruptured aneurysms, post-operative clinical vasospasm, presence of contralateral weakness, lower pre/post-operative Glasgow coma scores, higher Hunt and Hess, World Federation of Neurosurgical Societies (WFNS) and modified-WFNS grades. Conclusion: The factors with a significant impact on the outcome of patients with surgically clipped ruptured middle cerebral artery aneurysms were GCS, WFNS, m-WFNS, H&H, contralateral muscle weakness, size of the aneurysm, presence of other unruptured aneurysms and clinical vasospasm.

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Coiling and clipping of middle cerebral artery aneurysms: a systematic review on clinical and imaging outcome

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011478 ◽

2014 ◽

Vol 8 (1) ◽

pp. 24-29 ◽

Cited By ~ 13

Author(s):

IJsbrand A Zijlstra ◽

Dagmar Verbaan ◽

Charles B Majoie ◽

Peter Vandertop ◽

Rene van den Berg

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Mortality And Morbidity ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Morphological Aspects ◽

Standardized Reporting ◽

Aneurysm Occlusion ◽

Mca Aneurysm ◽

Middle Cerebral Artery Aneurysms

BackgroundThere is an ongoing debate on the preferred treatment of middle cerebral artery (MCA) aneurysms. The purpose of this study was to assess the clinical and imaging outcomes comparing conventional coiling and clipping of unruptured and ruptured MCA aneurysms.MethodsWe searched the electronic databases PubMed, EMBASE, and Cochrane from January 1990 to May 2014.Results51 studies were included in the analysis. Favorable outcome was reported in 97.0% and 77.1%, and in 97.2% and 72.8% of patients after coiling and clipping of unruptured and ruptured aneurysms, respectively. Death rates were 1.1% and 8.4% after coiling and 0.3% and 14.7% after clipping of unruptured and ruptured aneurysms, respectively. Initial adequate occlusion was obtained in 89.6% and 92.1% after coiling of unruptured and ruptured aneurysms, respectively. Only three studies on clipping reported on aneurysm occlusion during follow-up.ConclusionsBoth coiling and clipping are procedures with low mortality and morbidity rates and, although it may seem that coiling is better for ruptured aneurysms and clipping for unruptured aneurysms, no firm conclusions can be drawn due to the variation in study design and lack of standardized reporting on MCA aneurysm treatments. Standardized observational studies from prospectively kept databases are needed to allow stronger conclusions to be drawn on what is the best treatment for MCA aneurysms. Comparable with aneurysms in other locations, a multidisciplinary approach is therefore recommended with selection of treatment modality based on the clinical condition of the patient and the morphological aspects of the aneurysm.

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