scholarly journals 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

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.

Coil Embolization of Unruptured Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. 346-354 ◽  
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.

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.

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.

scholarly journals Angiographic Morphological Characteristics of Middle Cerebral Artery aneurysms

2018 ◽  
Vol 24 (3) ◽  
pp. 208-211
Author(s):  
Antônio Santos de Araújo Junior ◽  
Paulo Henrique Pires De Aguiar ◽  
Daniel De Carvalho Kirchhoff ◽  
Apio Cláudio Antunes ◽  
Marco Antonio Stefani ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Morphological Characteristics ◽  
Aneurysm Rupture ◽  
The Other ◽  
Single Institution ◽  
Unruptured Aneurysms ◽  
Middle Cerebral Artery Aneurysms ◽  
Vascular Neurosurgery ◽  
Time Of Admission

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.

scholarly journals Remote results of endovascular treatment of middle cerebral artery aneurysms

2015 ◽  
Vol 17 (2) ◽  
pp. 28
Author(s):  
D. V. Shcheglov
Keyword(s):  
Postoperative Complications ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Considerable Increase ◽  
Mass Effect ◽  
Endovascular Occlusion ◽  
Middle Cerebral Artery Aneurysms

Our objective was to study the dynamics of remote results of MCA SA endovascular occlusion. 149 patients with MCA SA were examined and operated, 127 patients were selected for 36 months follow-up, 112 patients in 1 year follow-up, 52 patients were to be examined in 23 years, 17 in 45 years and 14 patients in more than 5 years. Endovascular occlusion was carried out by means of different coils during reconstructive 138 (92.6%) and unplanned deconstructive occlusions 8 (5.4%). For planned deconstructions detachable balloons were used 3 (2%). 17 (11.4%) recurrences were diagnosed and 12 (8%) repeated operations were performed. 19 (12.8%) intra-and postoperative complications/ predictors and 18 (12.1%) complications unrelated to surgery were observed in the first 30 days and only 1 (1.1%) mass effect was identified in 36 months. After our research we were ableto trackthe dynamicsof thepatientslife quality according totheRankinscale; tomonitorthe changes in SA occlusion degree; to define the frequency of recurrences and complications/predictors of complications and to determine the amount of reoperations. We noted a considerable increase in the quantity of total occlusions after reoperations, which resulted in much better filling of the CA cavity, because the prophylaxis of the repeated hemorrhages is the main goal of SA endovascular treatment.

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

2015 ◽  
Vol 8 (3) ◽  
pp. 287-294 ◽  
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.

Giant middle cerebral artery aneurysms: A 55-patient series

2021 ◽  
Author(s):  
Yuri Pilipenko ◽  
Shalva Eliava ◽  
Arevik Abramyan ◽  
Fedor Grebenev ◽  
Tatiana Birg ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Patient Series ◽  
Middle Cerebral Artery Aneurysms

Endovascular Treatment of 174 Middle Cerebral Artery Aneurysms: Clinical Outcome and Radiologic Results at Long-term Follow-up

Radiology ◽  
2009 ◽  
Vol 253 (1) ◽  
pp. 191-198 ◽  
Author(s):  
Jean-François Vendrell ◽  
Nicolas Menjot ◽  
Vincent Costalat ◽  
Denis Hoa ◽  
Jorge Moritz ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Long Term Follow Up ◽  
Middle Cerebral Artery Aneurysms

Surgical treatment of middle cerebral artery aneurysms

1984 ◽  
Vol 61 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Jiro Suzuki ◽  
Takashi Yoshimoto ◽  
Takamasa Kayama
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Surrounding Tissue ◽  
Surgical Results ◽  
Content Type ◽  
Aneurysm Neck ◽  
Social Lives ◽  
Middle Cerebral Artery Aneurysms ◽  
Fine Print

✓ The authors report their experience with the surgical therapy of middle cerebral artery (MCA) aneurysms in 413 cases, and describe their technique. After the M1 portion of the MCA is identified, the Sylvian fissure is opened. During the administration of 20% mannitol, temporary occluding clips are applied to the feeding and draining vessels of the aneurysm. The aneurysm is freed from all surrounding tissue, and the aneurysm neck is treated by ligation, clipping, or wrapping. Analysis of surgical results in 91 cases operated on after the surgical approach had become standardized indicates that more than 94% of patients have returned to useful social lives by the time of follow-up evaluation. Twenty-four percent of these patients were operated on within 48 hours after subarachnoid hemorrhage.

Endoluminal flow diverting stents for middle cerebral artery bifurcation aneurysms: multicenter cohort

2021 ◽  
pp. neurintsurg-2021-018224
Author(s):  
Mohamed M Salem ◽  
Mirhojjat Khorasanizadeh ◽  
Sovann V Lay ◽  
Leonardo Renieri ◽  
Anna L Kuhn ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Safety And Efficacy ◽  
Complete Occlusion ◽  
Maximal Diameter ◽  
Increased Risk ◽  
Ischemic Complications ◽  
Male Sex ◽  
Radiographic Data

BackgroundData regarding the safety and efficacy of flow diverting stents (FDS) in the treatment of middle cerebral artery (MCA) bifurcation aneurysms are scarce and limited to small single center series, with particular concern for increased risk of ischemic complications with jailing one of the M2 branches.MethodsProspectively-maintained databases at six North American and European centers were queried for patients harboring MCA bifurcation aneurysms undergoing treatment with FDS (2011–2018). The pertinent clinical and radiographic data were collected and analyzed.Results87 patients (median age 60 years, 69% females) harboring 87 aneurysms were included. The majority of aneurysms were unruptured (79%); 75.9% were saccular with a median maximal diameter of 8.5 mm. Radiographic imaging follow-up was available in 88.5% of cases at a median of 16.3 months post-treatment, showing complete occlusion in 59% and near complete occlusion (90–99%) in 18% of aneurysms. The overall rate of ischemic and hemorrhagic complications was 8% and 1.1%, respectively. Symptomatic and permanent complications were encountered in 5.7% and 2.3% of patients respectively, with retreatment pursued in 2.3% of patients. Jailed branch occlusion was detected in 11.5% of cases, with clinical sequelae in 2.3%. Last follow-up modified Rankin Scale of 0–2 was noted in 96.8% of patients. On multivariate analysis, male sex was the only independent predictor of aneurysmal persistence at last follow-up imaging (p=0.019).ConclusionFDS treatment for MCA bifurcation aneurysms is feasible, with comparable safety and efficacy profiles to other available endovascular options when utilized in carefully selected aneurysms. Jailing of M2 branches was not associated with a higher risk of post-procedural ischemic complications.

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