scholarly journals The role of gender, age and localization in the clinical manifestation of the cerebral bifurcational-hemodynamic arterial aneurysms

2020 ◽  
Vol 32 (2) ◽  
pp. 47-57
Author(s):  
S.O. Lytvak ◽  
M.V. Eleinik ◽  
L.M. Yakovenko ◽  
T.A. Malysheva
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Clinical Manifestation ◽  
Cerebral Artery ◽  
Significant Relationship ◽  
Internal Carotid ◽  
Anterior Communicating Artery ◽  
Female Ratio ◽  
Arterial Aneurysms

Objective ‒ to evaluate the influence of age, gender and localization on the clinical manifestation of cerebral bifurcational-hemodynamic arterial aneurysms (AA).Materials and methods. The retrospective study is based on the results of a comprehensive examination and surgical treatment of 547 (100 %) patients with bifurcational-hemodynamic cerebral AA in the Department of neurosurgical pathology of head and neck vessels of Romodanov Neurosurgery Institute during the period from 2011 till 2019. Recruiting of the patient to the clinical groups was done during the period between 2011‒2016 with their follow-up examination until 2019. It were enrolled 268 ((49.0 ± 4.2) %) men and 279 ((51.0 ± 4.2) %) women with bifurcational-hemodynamic aneurysms. The age of the patients was 18‒84 years (mean age ‒ 49,0±12,2 year).Results. Clinical manifestation of the cerebral bifurcational-hemodynamic AA was more often seen in patients during working age (16‒60 years) — 430 ((78.5 ± 3.4) %) patients, more often in men (p˂0.05). The peak frequency of clinical manifestation of AA ‒ 34.2 % (187 patients) was seen in the age interval 51‒60 years (the male/female ratio ‒ 51.3 % (96) and 48.7 % (91)). In patients with AA, a significant predominance of women was observed in age group older 61 years (χ2 = 21.68, p <0.001, φ = 0.20). There was no statistically significant relationship between the frequency of clinical manifestation of AA and the patient’s age. However, there is a statistically significant relationship between gender and age in some locations. The percentage of patients with AA complex of the anterior cerebral-anterior communicating artery among women is 62.5 ± 15.0 (25/40, after 60 years it’s in 1.7 times higher than among men 37.5 ± 15.0 (15/40). While before the age of 61, there is a 1.6-fold increase in men, 61.3 ± 7.5 (100/163). For the internal carotid artery segments, the percentage of patients who underwent AA among women is 81.6 ± 12.0 (31/38), after 60 years it is in 4.4 times higher than among men 18.4 ± 12.0 (7/38). For the middle cerebral artery, the percentage among women is 73.1 ± 17.4% (19/26), after 60 years it is in 2.7 times higher than in men 6.4 ± 17.7% (7/26). Until the age of 61, the gender difference in the internal carotid artery and the middle cerebral artery segments does not reach a statistically significant level (p> 0.05). At other localizations, gender-age dependence was not observed. Multiple cerebral aneurysmal lesions were associated with clinical manifestation at the age of 41‒50 years in males with 3 AA.Conclusions. A statistically significant influence of age, gender and the presence of multiple cerebral AA on the clinical manifestation of the disease was revealed. Localization of AA did not affect the timing of the clinical manifestation.

Tandem middle cerebral artery–internal carotid artery occlusions: reduced occlusion-to-revascularization time using a trans–anterior communicating artery approach with a Penumbra device

2012 ◽  
Vol 116 (3) ◽  
pp. 665-671 ◽  
Author(s):  
David J. Padalino ◽  
Eric M. Deshaies
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Ischemic Injury ◽  
Acute Onset ◽  
Anterior Communicating Artery ◽  
Scale Scores

Rapid revascularization of tandem extracranial and intracranial acute thromboembolic occlusions can be challenging and can delay restoration of blood flow to the cerebral circulation. Taking advantage of collateral pathways in the circle of Willis for thrombectomy can reduce the occlusion-to-revascularization time significantly, thereby protecting brain tissue from ischemic injury. The authors report using the trans–anterior communicating artery (ACoA) approach by using the Penumbra microcatheter to rapidly restore blood flow to the middle cerebral artery (MCA) territory prior to treating the ipsilateral internal carotid artery (ICA) occlusion. Two patients with acute onset of tandem ipsilateral ICA and MCA occlusions and a competent ACoA underwent rapid revascularization of the MCA using a trans-ACoA approach for pharmaceutical and mechanical thrombolysis with the 0.026-in Penumbra microcatheter. Subsequently, once blood flow was reestablished in the MCA territory via cross-filling from the contralateral ICA, the proximally occluded ICA dissection was revascularized with a stent. Both patients had rapid revascularization of the MCA territory (both Thrombolysis in Myocardial Infarction Grade 3) with the trans-ACoA approach (19 and 36 minutes) followed by treatment of the ipsilateral proximal ICA occlusion. This prevented prolonged MCA ischemia time (72 and 47 minutes for ICA revascularization time saved) that would have otherwise occurred if the dissections were treated prior to revascularization of the MCA. Both patients had improved NIH Stroke Scale scores after the procedure. No adverse events from crossing the ACoA with the Penumbra microcatheter were encountered during the revascularization procedure. The trans-ACoA approach with the Penumbra microcatheter for rapid revascularization of an acutely thrombosed MCA in the setting of a simultaneous ipsilateral proximal ICA occlusion is feasible in patients with a competent ACoA. This technique can significantly minimize ischemic injury by reducing the occlusion-to-revascularization time and allow for MCA perfusion via collateral circulation while treating a proximal occlusion. To the best of the authors' knowledge, this is the first reported trans-ACoA approach with the Penumbra microcatheter and the first to report the utilization of the collateral intracranial circulation to reduce occlusion-to-revascularization time.

scholarly journals Anatomy of the Middle Cerebral Artery and some related arteries on 256 MSCT

2019 ◽  
Vol 35 (2) ◽  
Author(s):  
Nguyen Tuan Son ◽  
Ngo Xuan Khoa ◽  
Nguyen Quoc Dung ◽  
Dao Dinh Thi
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Anterior Communicating Artery ◽  
Microsurgical Anatomy ◽  
Medical University

Abstracts: Introduction: studying the percentage of display and dimensions of the middle cerebral artery and some related arteries on on  256 MSCT data. Methods: A cross-sectional study, with sample size of 261. Results: The percentage of display of middle cerebral artery is 100%; the posterior artery is 76.4; Internal Carotid Artery is 100%. The average diameter, average length are (mm) M1T respectively: 3.25 ± 0.43 and 19.98 ± 6.10; M1 P: 3.26 ± 0.46 and 19.68 ± 6.28; M2T left 2.10 ± 0.48 and 22.85 ± 13.18; M2T right 2.09 ± 0.49 and 23.42 ± 11.89; M2D left 2.48 ± 0.49 and 31.73-16.36; M2D  right 2.55 ± 0.49 and 29.11 ± 15.31. PCoA T 1.29 ± 0.63 and 11.87 ± 4.87; PCoA P 1.26 ± 0.66 and 14.02 ± 9.13; Conclusions: The size of the middle cerebral artery and some related  arteries were accurately evaluated in the study, the image of vascular anatomy was display clearly. Keywords Middle cerebral artery, cerebral angiography, multi-slices computed tomography ... References [1] H.V. Cúc. To the study of arterial blood supply vessels for Vietnamese adults, Ministry of Health research project, Hanoi Medical University, Hanoi, Vietnam (2000) (in Vietnamese).[2] H.M.Tú. To the study of cerebral artery anatomy on MSCT 64 image, Master's thesis in Medicine, Hanoi Medical University, Hanoi, Vietnam (2011) (in Vietnamese).[3] Ogeng'o, J.A. Geometric features of Vertebrobasilar arterial system in adult Black Kenyans, Int. J. Morphol, 36(2) (2018) 544 - 50. [4] KrzyżewsKi, R.M.. Variation of the anterior communicating artery complex and occurrence of anterior communicating artery aneurysm: A2 segment consideration, Folia medica cracoviensia, LIV (1) (2014) 13 - 20.[5] Jiménez-Sosa, M.S. Anatomical variants of Anterior cerebral arterial circle. A study by Multidetector computerized 3D tomographic angiography, Int J. Morphol 35(3) 1121 – 28.[6] Hamidi, C. (2013). Display with 64-detector MDCT angiography of cerebral vascular variations, Surg Radiol Anat 35 (2017) 729 – 36.[7] Dimmick, S.J., et al. Normal variations of the cerebral circulation at multidetector CT angiography, Radiographics 29(4) (2009) 1027 – 43.[8] P.T.Hà. To the study of Willis polygonal anatomy on MSCT 128 image of patients with cerebral aneurysm, Specialish level 2 thesis in Hanoi Medical University, Hanoi, Vietnam.[9] Saha, A. (2013). Variation of posterior communicating artery in human brain: a morphological study, Gomal Journal of Medical Sciences 11(1) (2018). 42 – 6.[10] Gullari, G. K. The branching pattern of the middle cerebral artery: is the intermediate trunk real or not? An anatomical study correlating with simple angiography, J.Neurosurg, 116 (2012) 1024 - 34.[11] Canaz, H., el al Morphometric analysis of the arteries of Willis Polygon, Romanian Neurosurgery, XXXII (1) (2018) 56 - 64.[12] Pedroza, A. (1987). Microanatomy of the Posterior Communicating Artery, Neurosurgery 20(2) (2018) 229 – 35.[13] Keeranghat, P. P., et al. Evaluation of normal variants of circle of Willis at MRI, Int.J. Res Med Sci, 6(5) (2018) 1617 - 22.[14] Tao, X., Yu, et al. Microsurgical anatomy of the anterior communicating artery complex in adult Chinese heads, Surgical Neurology 65 (2006) 155 – 61.[15] Krejza, J., et al. Carotid artery diameter in Men and Women and the relation to body and neck size, Stroke, 37 (2006) 1103 - 5.[16] Masatoukawashima. Microsurgical anatomy of cerebral revascularization. Part I: Anterior circulation, J.Neurosurg, 102 (2005) 116 – 31.[17] Jeyakumar.R., et al, Study of Anatomical Variations in Middle Cerebral Artery, Int.J.Sci Stud 5(12) (2018) 5-10. [18] Brzegowy, P, et al Middle cerebral artery anatomical variations and aneurysms: a retrospective study based on computed tomography angiography findings, Folia Morphol, 77(3) (2018) 434 – 40.[19] Rohan, V., et al, Length of Occlusion predicts recanalization and outcome after intravenous thrombolysis in middle cerebral artery stroke, Stroke, 45 (2014) 2010 - 17.[20] Vijaywargiya, M., et al. Anatomical study of petrous and cavernous parts of internal carotid artery, Anat Cell Biol, 50 (2017) 163 - 70.[21] Bouthillier, et al Segments of the internal carotid artery: a new classification, Neurosurgery, 38(3), (1996) 425 - 32.  

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.

Blister Aneurysms of the Internal Carotid Artery: Microsurgical Results and Management Strategy

Neurosurgery ◽  
2017 ◽  
Vol 80 (2) ◽  
pp. 235-247 ◽  
Author(s):  
Christopher M. Owen ◽  
Nicola Montemurro ◽  
Michael T. Lawton
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Treatment Strategy ◽  
Internal Carotid ◽  
Artery Bypass ◽  
External Carotid ◽  
Parent Artery ◽  
Intraoperative Rupture

Abstract BACKGROUND: Blister aneurysms of the supraclinoid internal carotid artery (ICA) are challenging lesions with high intraoperative rupture rates and significant morbidity. An optimal treatment strategy for these aneurysms has not been established. OBJECTIVE: To analyze treatment strategy, operative techniques, and outcomes in a consecutive 17-year series of ICA blister aneurysms treated microsurgically. METHODS: Seventeen patients underwent blister aneurysm treatment with direct clipping, bypass and trapping, or clip-reinforced wrapping. RESULTS: Twelve aneurysms (71%) were treated with direct surgical clipping. Three patients required bypass: 1 superficial temporal artery to middle cerebral artery bypass, 1 external carotid artery to middle cerebral artery bypass, and 1 ICA to middle cerebral artery bypass. One patient was treated with clip-reinforced wrapping. Initial treatment strategy was enacted 71% of the time. Intraoperative rupture occurred in 7 patients (41%), doubling the rate of a poor outcome (57% vs 30% for patients with and without intraoperative rupture, respectively). Severe vasospasm developed in 9 of 16 patients (56%). Twelve patients (65%) were improved or unchanged after treatment, and 10 patients (59%) had good outcomes (modified Rankin Scale scores of 1 or 2). CONCLUSION: ICA blister aneurysms can be cautiously explored and treated with direct clipping as the first-line technique in the majority of cases. Complete trapping of the parent artery with temporary clips and placing permanent clip blades along normal arterial walls enables clipping that avoids intraoperative aneurysm rupture. Trapping/bypass is used as the second-line treatment, maintaining a low threshold for bypass with extensive or friable pathology of the carotid wall and in patients with incomplete circles of Willis.

Bilateral Internal Carotid to Anterior Cerebral Artery Anastomosis with Anterior Communicating Artery Aneurysm: Technical Case Report

2005 ◽  
Vol 57 (suppl_4) ◽  
pp. ONS-E400-ONS-E400 ◽  
Author(s):  
Kaya Kılıç ◽  
Metin Orakdöğen ◽  
Aram Bakırcı ◽  
Zafer Berkman
Keyword(s):  
Case Report ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery

Abstract OBJECTIVE AND IMPORTANCE: The present case report is the first one to report a bilateral anastomotic artery between the internal carotid artery and the anterior communicating artery in the presence of a bilateral A1 segment, fenestrated anterior communicating artery (AComA), and associated aneurysm of the AComA, which was discovered by magnetic resonance angiography and treated surgically. CLINICAL PRESENTATION: A 38-year-old man who was previously in good health experienced a sudden onset of nuchal headache, vomiting, and confusion. Computed tomography revealed a subarachnoid hemorrhage. Magnetic resonance angiography and four-vessel angiography documented an aneurysm of the AComA and two anastomotic vessels of common origin with the ophthalmic artery, between the internal carotid artery and AComA. INTERVENTION: A fenestrated clip, introduced by a left pterional craniotomy, leaving in its loop the left A1 segment, sparing the perforating and hypothalamic arteries, excluded the aneurysm. CONCLUSION: The postoperative course was uneventful, with complete recovery. Follow-up angiograms documented the successful exclusion of the aneurysm. Defining this particular internal carotid-anterior cerebral artery anastomosis as an infraoptic anterior cerebral artery is not appropriate because there is already an A1 segment in its habitual localization. Therefore, it is also thought that, embryologically, this anomaly is not a misplaced A1 segment but the persistence of an embryological vessel such as the variation of the primitive prechiasmatic arterial anastomosis. The favorable outcome for our patient suggests that surgical treatment may be appropriate for many patients with this anomaly because it provides a complete and definitive occlusion of the aneurysm.

Critical neurovascular brain anatomy

2010 ◽  
pp. 504-517
Author(s):  
George Samandouras
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Basilar Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Brain Anatomy ◽  
Vertebral Arteries ◽  
System P

Chapter 9.1 covers critical neurovascular brain anatomy, including internal carotid artery, the middle cerebral artery, the anterior cerebral artery, the vertebral arteries (VAs), the basilar artery (BA), and the venous system.

scholarly journals Origins and Pathways of Cerebrovascular Vasoactive Intestinal Polypeptide-Positive Nerves in Rat

1988 ◽  
Vol 8 (5) ◽  
pp. 697-712 ◽  
Author(s):  
Norihiro Suzuki ◽  
Jan Erik Hardebo ◽  
Christer Owman
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Vasoactive Intestinal Polypeptide ◽  
Basilar Artery ◽  
Internal Carotid ◽  
Sphenopalatine Ganglion ◽  
Cerebral Blood Vessels ◽  
Carotid Canal

In order to clarify the origins and pathways of vasoactive intestinal polypeptide (VlP)-containing nerve fibers in cerebral blood vessels of rat, denervation experiments and retrograde axonal tracing methods (true blue) were used. Numerous VIP-positive nerve cells were recognized in the sphenopalatine ganglion and in a mini-ganglion (internal carotid mini-ganglion) located on the internal carotid artery in the carotid canal, where the parasympathetic greater superficial petrosal nerve is joined by the sympathetic fibers from the internal carotid nerve, to form the Vidian nerve. VIP fiber bridges in the greater deep petrosal nerve and the internal carotid nerve reached the wall of the internal carotid artery. Two weeks after bilateral removal of the sphenopalatine ganglion or sectioning of the structures in the ethmoidal foramen, VIP fibers in the anterior part of the circle of Willis completely disappeared. Very few remained in the middle cerebral artery, the posterior cerebral artery, and rostral two-thirds of the basilar artery, whereas they remained in the caudal one-third of the basilar artery, the vertebral artery, and intracranial and carotid canal segments of the internal carotid artery. One week after application of true blue to the middle cerebral artery, dye accumulated in the ganglion cells in the sphenopalatine, otic and internal carotid mini-ganglion; some of the cells were positive for VIP. The results show that the VIP nerves in rat cerebral blood vessels originate: (a) in the sphenopalatine, and otic ganglion to innervate the circle of Willis and its branches from anterior and caudally and (b) from the internal carotid mini-ganglion to innervate the internal carotid artery at the level of the carotid canal and to some extent its intracranial extensions.

Sign in / Sign up

Export Citation Format

Share Document