Intraoperative monitoring of blood flow insufficiency during surgery of middle cerebral artery aneurysms

2005 ◽  
Vol 103 (2) ◽  
pp. 275-283 ◽  
Author(s):  
Kazuomi Horiuchi ◽  
Kyouichi Suzuki ◽  
Tatsuya Sasaki ◽  
Masato Matsumoto ◽  
Jun Sakuma ◽  
...  
Keyword(s):  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Evoked Potential ◽  
Control Level ◽  
The Other ◽  
Somatosensory Evoked Potential ◽  
Content Type ◽  
Sep Monitoring ◽  
Fine Print

Object. The usefulness of motor evoked potential (MEP) monitoring to detect blood flow insufficiency (BFI) in the cortical branches of the middle cerebral artery (MCA) and lenticulostriate arteries (LSAs) during MCA aneurysm surgery was investigated based on the correlation between MEP and somatosensory evoked potential (SEP) monitoring. Methods. Fifty-three patients with MCA aneurysms underwent surgery accompanied by intraoperative MEP and SEP monitoring. There was no postoperative motor paresis in 43 patients in whom MEP and SEP results remained unchanged. In the other 10 patients, nine manifested transient MEP changes; in five of these, SEP changes did not occur. The transient MEP changes were thought to be attributable to BFI of the MCA cortical branches in two patients, the LSA in three, and either the MCA branches or the LSA in four patients. Of these nine patients, six did not present with postoperative motor paresis; transient motor paresis was recognized in the other three. In the 10th patient, MEP waves disappeared and did not recover. This patient's SEPs remained at 70% of the control level, and he developed severe hemiparesis. A postoperative computerized tomography scan revealed a new low-density area in the corona radiata and putamen. Conclusions. Blood flow insufficiency in both the LSA and MCA cortical branches that perfuse the corticospinal tract can be detected by intraoperative MEP monitoring. Somatosensory evoked potential monitoring is not reliable enough to detect BFI in the MCA branches and the LSAs.

Thresholds of focal cerebral ischemia in awake monkeys

1981 ◽  
Vol 54 (6) ◽  
pp. 773-782 ◽  
Author(s):  
Thomas H. Jones ◽  
Richard B. Morawetz ◽  
Robert M. Crowell ◽  
Frank W. Marcoux ◽  
Stuart J. FitzGibbon ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Ischemia ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Focal Cerebral Ischemia ◽  
Neurological Function ◽  
Local Flow ◽  
Content Type ◽  
Mca Occlusion ◽  
Fine Print

✓ An awake-primate model has been developed which permits reversible middle cerebral artery (MCA) occlusion during physiological monitoring. This method eliminates the ischemia-modifying effects of anesthesia, and permits correlation of neurological function with cerebral blood flow (CBF) and neuropathology. The model was used to assess the brain's tolerance to focal cerebral ischemia. The MCA was occluded for 15 or 30 minutes, 2 to 3 hours, or permanently. Serial monitoring evaluated neurological function, local CBF (hydrogen clearance), and other physiological parameters (blood pressure, blood gases, and intracranial pressure). After 2 weeks, neuropathological evaluation identified infarcts and their relation to blood flow recording sites. Middle cerebral artery occlusion usually caused substantial decreases in local CBF. Variable reduction in flow correlated directly with the variable severity of deficit. Release of occlusion at up to 3 hours led to clinical improvement. Pathological examination showed microscopic foci of infarction after 15 to 30 minutes of ischemia, moderate to large infarcts after 2 to 3 hours of ischemia, and in most cases large infarcts after permanent MCA occlusion. Local CBF appeared to define thresholds for paralysis and infarction. When local flow dropped below about 23 cc/100 gm/min, reversible paralysis occurred. When local flow fell below 10 to 12 cc/100 gm/min for 2 to 3 hours or below 17 to 18 cc/100 gm/min during permanent occlusion, irreversible local damage was observed. These studies imply that some cases of acute hemiplegia, with blood flow in the paralysis range, might be improved by surgical revascularization. Studies of local CBF might help identify suitable cases for emergency revascularization.

Experimental microsurgical embolectomy after middle cerebral artery embolization in the dog

1983 ◽  
Vol 58 (2) ◽  
pp. 259-266 ◽  
Author(s):  
Yoshikazu Okada ◽  
Takeshi Shima ◽  
Shuichi Oki ◽  
Tohru Uozumi
Keyword(s):  
Blood Flow ◽  
Cerebral Infarction ◽  
Evoked Potentials ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Control Level ◽  
Neurological Deficits ◽  
Content Type ◽  
Sensory Evoked Potentials ◽  
Sensory Evoked

✓ The effects of microsurgical embolectomy were investigated clinicopathophysiologically in 60 dogs after occlusion of the middle cerebral artery (MCA) trunk with a silicone cylinder embolus. One group of animals served as a control (non-embolectomized group), and in the other two groups the embolus was removed 3 or 6 hours after occlusion (3-hour or 6-hour embolectomy group). In the non-embolectomized animals, major neurological deficits with deep cerebral infarction were observed. Regional cerebral blood flow (CBF) in the basal ganglia decreased most prominently. Sensory evoked potentials also declined to about 50% of the control level 3 hours after embolization. In the 3-hour embolectomy group, mild neurological deficits with minimal infarctions were found. One hour after embolectomy, CBF was restored to the original level in all regions, and the sensory evoked potentials surpassed the control level. In the 6-hour embolectomy group, most animals exhibited major neurological deficits and severe brain swelling with hemorrhagic infarction. This study suggests that early microsurgical embolectomy of the MCA trunk restores blood flow in the perforating arteries and prevents deep cerebral infarction.

Cerebral dissecting aneurysm and intimal fibroelastic thickening of cerebral arteries

1982 ◽  
Vol 56 (4) ◽  
pp. 571-576 ◽  
Author(s):  
Tomohiko Mizutani ◽  
Herbert I. Goldberg ◽  
Justin Parr ◽  
Clive Harper ◽  
Carson J. Thompson
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cerebral Arteries ◽  
Dissecting Aneurysm ◽  
The Other ◽  
Left Middle Cerebral Artery ◽  
Similar Distribution ◽  
Content Type ◽  
Left Middle ◽  
Fine Print

✓ A 19-year-old white man developed aphasia and right hemiplegia after several falls while waterskiing. Cerebral angiography displayed a ripple appearance and a “string of beads” sign along the left middle cerebral artery, with occlusion or stenosis of most of its branches. The patient died after 6 days, of transtentorial herniation due to massive left cerebral infarction. At necropsy, the infarct was found to be due to a subintimal dissecting aneurysm of the left middle cerebral artery. Multifocal areas of intimal fibroelastic thickening (IFT) were found not only at the site of dissection, but also in the other cerebral arteries, most prominent at the bifurcations of the vessels. A systematic study of cerebral arteries performed in six control cases revealed that IFT was present in a similar distribution to that seen in the patient described. However, the degree of IFT in this patient was greater than in the controls. Some individuals with excessive IFT may be more susceptible to cerebral dissecting aneurysm under a variety of stresses, especially trauma.

Thrombectomy of the middle cerebral artery

1975 ◽  
Vol 42 (6) ◽  
pp. 723-725 ◽  
Author(s):  
Ephraim I. Zlotnik
Keyword(s):  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Content Type ◽  
Fine Print

✓ A case is described in which thrombectomy of the middle cerebral artery by way of one of its side branches successfully restored blood flow in the artery and resulted in marked regression of neurological disturbances.

Middle meningeal to middle cerebral arterial bypass for cerebral revascularization

1979 ◽  
Vol 50 (6) ◽  
pp. 802-804 ◽  
Author(s):  
Clinton F. Miller ◽  
Robert F. Spetzler ◽  
Dennis J. Kopaniky
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Middle Meningeal Artery ◽  
Cerebral Revascularization ◽  
Content Type ◽  
Arterial Bypass ◽  
Meningeal Artery ◽  
Fine Print

✓ A case is reported of successful anastomosis of the middle meningeal artery to a cortical branch of the middle cerebral artery. Based on the analyses of 50 random angiograms, the authors discuss the circumstances in which such an anastomosis might be practical and indicated.

Posttraumatic bilateral middle cerebral artery occlusion

1975 ◽  
Vol 42 (2) ◽  
pp. 217-221 ◽  
Author(s):  
Skip Jacques ◽  
C. Hunter Shelden ◽  
D. Thomas Rogers ◽  
Anthony C. Trippi
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Content Type ◽  
Pathophysiological Mechanisms ◽  
Cerebral Artery Occlusion ◽  
Fine Print

✓ The authors report a case of bilateral posttraumatic middle cerebral artery occlusion. Previously reported unilateral cases are reviewed and possible pathophysiological mechanisms disscussed.

Angiographic extravasation of contrast medium in acute traumatic subdural hematoma from arterial rupture

1972 ◽  
Vol 37 (2) ◽  
pp. 226-228 ◽  
Author(s):  
Jusuke Ito ◽  
Komei Ueki ◽  
Hisayuki Ishikawa
Keyword(s):  
Contrast Medium ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Subdural Hematoma ◽  
Carotid Angiography ◽  
Content Type ◽  
Arterial Rupture ◽  
Visual Evidence ◽  
Subpial Hemorrhage ◽  
Fine Print

✓ Carotid angiography of a patient with suspected subdural hematoma showed extravasation of the contrast medium from an ascending branch of the middle cerebral artery. The leak was verified at operation. There was no visual evidence of an aneurysm, angioma, subarachnoid or subpial hemorrhage.

Delayed breaking of a Heifetz aneurysm clip

1977 ◽  
Vol 47 (3) ◽  
pp. 463-465 ◽  
Author(s):  
Antti Servo ◽  
Matti Puranen
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Left Middle Cerebral Artery ◽  
Carotid Angiography ◽  
Content Type ◽  
Aneurysm Clip ◽  
Correct Placement ◽  
Left Middle ◽  
Fine Print

✓ An aneurysm of the left middle cerebral artery was treated by clipping with a Heifetz clip. The correct placement was confirmed angiographically immediately after the operation. At carotid angiography 1 year later the clip was found to have broken, and the aneurysm had increased in size.

The perforating branches of the middle cerebral artery

1985 ◽  
Vol 62 (2) ◽  
pp. 261-268 ◽  
Author(s):  
Felix Umansky ◽  
Francisco B. Gomes ◽  
Manuel Dujovny ◽  
Fernando G. Diaz ◽  
James I. Ausman ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Interventional Neuroradiology ◽  
Great Majority ◽  
Outer Diameter ◽  
Main Trunk ◽  
Content Type ◽  
Brain Hemispheres ◽  
Medial Group ◽  
Fine Print

✓ The perforating branches (PFB's) of the middle cerebral artery (MCA) were studied in 34 unfixed brain hemispheres which were injected with a polyester resin and dissected under the operating microscope. Five hundred and eight vessels were identified and their site of origin, branching pattern, outer diameter (OD), and length recorded. Four hundred and two PFB's (79%) originated from the main trunk of the MCA before its division; the remaining 106 vessels (21%) had their origin from branches of the MCA as follows: superior trunk, 43 vessels (8.5%); inferior trunk, 30 vessels (6%); middle trunk, four vessels (0.8%); early temporal branch, 27 vessels (5.3%); and early frontal branch, two vessels (0.4%). The number of PFB's in each hemisphere varied from five to 29 (mean 14.9 ± 0.7 vessels). The great majority of PFB's (96%) originated along the proximal 17 mm of the MCA. The PFB's arising in the first 10 mm had a mean OD of 0.35 ± 0.01 mm and a mean length of 9.25 ± 0.19 mm, and those arising from the second 10 mm had a mean OD of 0.47 ± 0.02 mm and a mean length of 16.67 ± 1.4 mm. A clear distinction between a medial and lateral group of PFB's was present in only 14 hemispheres (41%). In nine hemispheres (26%), perforating vessels from the anterior cerebral artery (A1 segment) and from the recurrent artery of Heubner replaced the medial group of PFB's of the MCA. In one case this group originated in an accessory MCA. In three hemispheres (9%) a small anastomosis (OD 0.2 mm) was seen between a PFB of the recurrent artery of Heubner and one of the MCA. From a total of 508 PFB's, 255 vessels (50%) originated as single vessels, while 253 vessels (50%) originated as branches of common stems. The OD of the single vessels ranged from 0.1 mm to 1.1 mm (mean 0.39 ± 0.02 mm), and the length from 3 to 20 mm (mean 10.8 ± 0.2 mm). The common stems ranged in OD from 0.6 to 1.8 mm (mean 0.87 ± 0.04 mm), and in length from 1 to 15 mm (mean 4.1 ± 0.4 mm). The clinical application of these anatomical data to the management of aneurysms and arteriovenous malformations of the MCA, and in the field of interventional neuroradiology is described. The most frequent pathological entities involving the perforating vessels are also discussed.

Superficial temporal-middle cerebral artery bypass

1979 ◽  
Vol 51 (4) ◽  
pp. 455-465 ◽  
Author(s):  
Richard E. Latchaw ◽  
James I. Ausman ◽  
Myoung C. Lee
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Collateral Circulation ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Change Over Time ◽  
Content Type ◽  
Over Time ◽  
Fine Print ◽  
Temporal Middle

✓ Pre- and postoperative angiograms on 40 patients undergoing superficial temporal-middle cerebral artery (STA-MCA) bypass surgery have been examined in detail. Multiple postoperative angiograms have been obtained to evaluate the change in both the bypass circuit and the intracranial circulation over time. A reproducible system for evaluating the degree of intracranial vascular filling via the bypass is introduced. The study shows that the STA and its anastomotic branch increase in size over time, measured in months, in the majority of patients. This is paralleled by a progressive increase in the degree of intracranial vascular filling. These changes are proportional to the severity of the vascular disease before surgery. The pattern of preoperative collateral circulation may change over time following the addition of the bypass circuit. The progressive change over time suggests that a static analysis at one time may belie the true effect of the surgery. The change of collateral circulation, with augmentation of blood supply to areas of the brain other than those affected by the recent ischemic event, means that a total cerebral evaluation including neuropsychological testing may be necessary for adequate evaluation of the effect of the bypass surgery.

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