scholarly journals Preoperative simulation of a middle cerebral artery aneurysm clipping using a rotational three-dimensional digital subtraction angiography

2021 ◽  
Vol 12 ◽  
pp. 70
Author(s):  
Yuiko Kimura ◽  
Toshihiro Mashiko ◽  
Eiju Watanabe ◽  
Kensuke Kawai
Keyword(s):  
Middle Cerebral Artery ◽  
Digital Subtraction Angiography ◽  
Cerebral Artery ◽  
Three Dimensional ◽  
Artery Aneurysm ◽  
Digital Subtraction ◽  
Preoperative Simulation ◽  
The Difference ◽  
Operative Findings ◽  
Cerebral Artery Aneurysm

Background: In recent years, young neurosurgeons have had few opportunities to gain experience with clipping surgeries. The first author was sometimes surprised that she could not predict the anatomical relationships between the aneurysm and vessels during actual surgery. This study investigated the differences between the expected and actual operative findings during clipping surgery for aneurysms of the middle cerebral artery. Methods: Medical records for 15 patients who underwent rotational three-dimensional (3D) digital subtraction angiography (3D-DSA) before the clipping surgery were analyzed after the surgery. The anatomical relationships between the aneurysm and parent arteries were defined by the intraoperative findings just before clipping. The viewing direction to obtain this definitive perspective (virtual viewing direction) was measured. The angle between this viewing direction and the coordinate axis was denoted as the “virtual angle for clipping (VAC).” Results: The VAC between the X-axis and viewing direction on the XY-plane (VAC-XY) ranged from –43° to +73° (mean, +27°), and the angle between the XY-plane and viewing direction (VAC-Z) ranged from +25° to –34° (mean, 5.5°). The difference between the VAC-XY and mean angle was significantly larger in cases with hidden branches behind the aneurysm. In these cases, the virtual viewing direction visualized the neck of the aneurysm. There is no correlation between M1 length and VAC-XY or VAC-Z discrepancy. Conclusion: 3D-DSA or 3D computed tomography angiography images visualizing the neck of the aneurysm should be obtained in combination with images obtained from the standard oblique angle.

Approach and Operative View for Middle Cerebral Artery Aneurysm: Retrospective Observations of 3D-DSA and Operative Findings.

2003 ◽  
Vol 31 (4) ◽  
pp. 258-262 ◽  
Author(s):  
Kensuke MURAKAMI ◽  
Noboru TAKAHASHI ◽  
Yasuhiro SUZUKI ◽  
Hiroaki NOMURA ◽  
Hiroshi MIDORIKAWA ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Middle Cerebral Artery Aneurysm ◽  
Operative Findings ◽  
Cerebral Artery Aneurysm

M2/M2 Side-to-Side Rescue Anastomosis for Accidental M2 Trunk Occlusion during Middle Cerebral Artery Aneurysm Clipping: Technical Note

Neurosurgery ◽  
2001 ◽  
Vol 49 (3) ◽  
pp. 743-748 ◽  
Author(s):  
Hans-Jakob Steiger ◽  
Seiro Ito ◽  
Robert Schmid-Elsässer ◽  
Eberhard Uhl
Keyword(s):  
Intracerebral Hemorrhage ◽  
Middle Cerebral Artery ◽  
Digital Subtraction Angiography ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Maximum Diameter ◽  
Digital Subtraction ◽  
Emergency Procedure ◽  
Aneurysm Clipping ◽  
Mca Aneurysm

Abstract OBJECTIVE A technically feasible and rapid technique for revascularizing the main branches of the middle cerebral artery (MCA) is described. This technique is applied mainly when clipping of an MCA aneurysm is complicated and occlusion of the origin of an MCA main branch results. METHODS M2/M2 side-to-side anastomosis was applied in two patients in whom unplanned M2 occlusion occurred during the course of complicated MCA aneurysm clipping. The first patient underwent an emergency procedure after temporoparietal intracerebral hemorrhage. Unilateral mydriasis precluded preoperative angiographic workup, and a complex large MCA aneurysm was found as the source of hemorrhage. Shaping of the aneurysm neck by bipolar coagulation and clipping resulted in accidental occlusion of the superior trunk, and patency could not be regained despite multiple clip corrections. The second patient had an unruptured multilobulated aneurysm 8 mm in maximum diameter. Continuity of the inferior trunk was lost during clipping because of a tear at the origin. In both instances, side-to-side anastomosis was placed approximately 15 mm from the bifurcation, where the MCA main trunks ran side by side for a length of approximately 5 mm. RESULTS After intracerebral hemorrhage, the first patient recovered to a level of moderate disability within 2 months. Substantial hemiparesis and expressive dysphasia remained as sequelae of the intracerebral hemorrhage. Digital subtraction angiography 2 months after the emergency procedure confirmed patency of the side-to-side anastomosis. The second patient was neurologically intact after recovery from anesthesia. Before discharge from the hospital on postoperative Day 8, digital subtraction angiography confirmed patency of the anastomosis. CONCLUSION The MCA main branches usually run in close proximity for a short segment at the bottleneck entrance to the insular cistern. M2/M2 side-to-side anastomosis at this site is a rapid and feasible mode of revascularization of an M2 trunk accidentally occluded during complicated MCA aneurysm clipping.

Sign in / Sign up

Export Citation Format

Share Document