scholarly journals Case Report: Ruptured Middle Cerebral Artery Aneurysm With Intrasylvian Hematoma Successfully Treated by Coil Embolization and Minimally Invasive Puncture and Drainage

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhen Li ◽  
Quan Hu ◽  
Li Zhao ◽  
Huayun Huang ◽  
Shizhong Zhang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Intracerebral Hematoma ◽  
Intracranial Hematomas ◽  
Mca Aneurysm ◽  
Poor Outcomes

Up to one-third (12–35%) of patients with aneurysmal subarachnoid hemorrhage experience intracerebral hematoma. Ruptured middle cerebral artery (MCA) aneurysm with hematoma is usually accompanied by progressive cerebral swelling with poor outcomes; however, it can be successfully treated by coil embolization and minimally invasive puncture and drainage. From February 2012 to March 2019, six surgeries for ruptured MCA aneurysms with intrasylvian hematoma were performed at our clinic. All patients had intracranial hematomas of <30 ml and GCS scores >8. The patients were treated by coil embolization and minimally invasive puncture and drainage. The aneurysms in all patients were completely embolized and the hematomas were mostly removed by minimally invasive puncture. The Glasgow outcome scale (GOS) scores of all patients were more than 4 at discharge when they discharged. Coil embolization and minimally invasive puncture and drainage are viable treatments for ruptured MCA aneurysms with hematomas, especially if the patient is too old, in a complicated state to undergo craniotomy, is unwilling to undergo craniotomy, or is at a greater risk of bleeding 3 days after surgery.

Ruptured Middle Cerebral Artery Aneurysm with Intracerebral Hemorrhage in Younger Patients Appearing Moribund: Emergency Operation?

Neurosurgery ◽  
1987 ◽  
Vol 20 (6) ◽  
pp. 925-929 ◽  
Author(s):  
Lennart Brandt ◽  
Bengt Sonesson ◽  
Bengt Ljunggren ◽  
Hans Säveland
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Emergency Operation ◽  
Neurological Deficits ◽  
Deep Coma ◽  
Intracerebral Hematoma ◽  
Clinical Appearance ◽  
Mca Aneurysm

Abstract Four women, aged 39 to 46 years, were urgently admitted to our neurosurgical unit after strokes. On admission, all appeared moribund, presenting with deep coma, pupils bilaterally dilated and fixed, decerebrate posture, and markedly abnormal respiratory patterns. Computed tomography revealed subarachnoid hemorrhage with an associated large intracerebral hematoma and pronounced shift of midline structures in all four cases. Because of the clinical appearance, the patients were given urea and were operated without preceding angiography. The origin of the hemorrhage was identified as a middle cerebral artery (MCA) bifurcation berry aneurysm in one patient and giant MCA aneurysms in the other three. The hematomas were evacuated, and the aneurysms were occluded. All four patients received intravenous nimodipine, none showed any sign of delayed ischemic deterioration, and all regained full consciousness within a few days. One patient died 3 weeks later from a pulmonary embolus. Three patients are presently at home with moderate focal neurological deficits and moderate to marked cognitive impairment. The psychosocial readjustment was very good in a patient with a left giant aneurysm, satisfactory in a patient with a right giant aneurysm, and unsatisfactory in a patient with a right berry aneurysm. The indications, ethical considerations, and technical aspects of operating on seemingly moribund patients who probably harbor a ruptured MCA aneurysm are discussed.

RUPTURED ANEURYSM AT THE PERFORATING ARTERY SUPPLYING THE INSULA

Neurosurgery ◽  
2009 ◽  
Vol 65 (1) ◽  
pp. E206-E207 ◽  
Author(s):  
Servet Inci ◽  
Atila Akbay ◽  
Burcu Hazer ◽  
Kivilcim Yavuz ◽  
Tuncalp Ozgen
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Clinical Presentation ◽  
Artery Aneurysm ◽  
Intracerebral Hematoma ◽  
Aged Patients ◽  
Perforating Artery ◽  
Proximal Middle Cerebral Artery ◽  
Small Aneurysm

Abstract OBJECTIVE Aneurysms originating from perforating branches of the middle cerebral artery are quite rare. Most of them arise from the lenticulostriate arteries, frequently located within the basal ganglia. We report a perforating artery aneurysm that was entirely embedded within the limen insulae. CLINICAL PRESENTATION A 41-year-old man presented with an insular hematoma without subarachnoid hemorrhage caused by rupture of a small aneurysm on a perforating artery of the proximal middle cerebral artery supplying the insula. INTERVENTION This rare aneurysm was resected via the transsylvian-insular approach. CONCLUSION Although very rare, perforating artery aneurysms should be considered in young or middle-aged patients with an atypical intracerebral hematoma. This report discusses radiological and surgical characteristics of this unusual aneurysm.

scholarly journals Orbitozygomatic Craniotomy for Clipping a Complex Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (2) ◽  
pp. E33-E33
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Video Recording ◽  
Artery Aneurysm ◽  
Sylvian Fissure ◽  
Parent Artery ◽  
Parent Vessel ◽  
Institutional Review ◽  
Vessel Patency ◽  
Mca Aneurysm

Abstract Middle cerebral artery (MCA) aneurysms pose a surgical challenge because of the large caliber of the parent artery and the common need to dissect the sylvian fissure to permit access to the proximal and distal control. The neck of the aneurysm should be generously dissected to permit visualization of any adjacent lenticulostriate perforators. This patient demonstrated a left-sided wide-necked bilobed MCA aneurysm at the M1 bifurcation. The aneurysm was approached using a left orbitozygomatic craniotomy with distal sylvian fissure dissection. A single curved clip was applied for aneurysm occlusion, and postoperative angiography demonstrated aneurysm obliteration with parent vessel patency. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Leo Stent-Assisted Coil Embolization of a Giant Middle Cerebral Artery Aneurysm

2008 ◽  
Vol 18 (3) ◽  
pp. 332-335 ◽  
Author(s):  
Jung Yong Ahn ◽  
Chang Ki Hong ◽  
Sang Hyun Suh ◽  
Jun Hyung Cho ◽  
Yo Shik Shim ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Artery Aneurysm ◽  
Middle Cerebral Artery Aneurysm ◽  
Cerebral Artery Aneurysm

scholarly journals Ruptured giant aneurysm of a cortical middle cerebral artery: A case report

2021 ◽  
Vol 12 ◽  
pp. 95
Author(s):  
Samer S. Hoz ◽  
Zaid Aljuboori ◽  
Sajaa A. Albanaa ◽  
Zahraa F. Al-Sharshahi ◽  
Mohammed A. Alrawi ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Giant Aneurysm ◽  
Neurological Deficits ◽  
Intracerebral Hematoma ◽  
Microsurgical Clipping ◽  
Level Of Consciousness ◽  
History Of ◽  
Posterior Parietal ◽  
Mca Aneurysm

Background: Aneurysms of the cortical branches of the middle cerebral artery (MCA) are rare. They usually are secondary to traumatic or infectious etiologies and are rarely idiopathic. The specific characteristics of idiopathic aneurysms in such location are not well defined in the literature. The authors report a rare case of a ruptured giant idiopathic cortical MCA aneurysm with review of the available literature on this clinical entity. Case Description: A 24-year-old female presented with headache, disturbed level of consciousness, and right-sided weakness. Imaging studies showed a left frontoparietal intracerebral hematoma and a giant saccular aneurysm in the posterior parietal cortical branch of the MCA. The patient had no history of head trauma or active infection; therefore, the aneurysm was considered idiopathic. A microsurgical clipping of the aneurysm with evacuation of the hematoma was performed. There were no surgical complications, and the patient achieved a good outcome modified Rankin Scale of 1 with no neurological deficits. Conclusion: Idiopathic aneurysms of the cortical branches of the MCA are rare, and usually present with intraparenchymal hemorrhage due to rupture. There is no clear consensus regarding the optimal management strategy. This case shows that timely management can lead to good outcomes.

Ruptured Duplicated Middle Cerebral Artery Aneurysm Successfully Treated by Coil Embolization with Balloon Remodeling

2018 ◽  
Vol 120 ◽  
pp. 509-510 ◽  
Author(s):  
Chun On Anderson Tsang ◽  
Lucy Smith ◽  
Jesse Klostranec ◽  
Emanuele Orru ◽  
Vitor Mendes Pereira
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Artery Aneurysm ◽  
Middle Cerebral Artery Aneurysm ◽  
Cerebral Artery Aneurysm

Double-Barrel Superficial Temporal Artery-M2 Middle Cerebral Artery Bypass and Creation of a Middle Communicating Artery via M2-M2 End-to-End Reimplantation for Trapping of a Dolichoectatic Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (5) ◽  
pp. E521-E522
Author(s):  
Joshua S Catapano ◽  
Fabio A Frisoli ◽  
Megan S Cadigan ◽  
Dara S Farhadi ◽  
Candice L Nguyen ◽  
...  
Keyword(s):  
Family History ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Superficial Temporal Artery ◽  
Artery Aneurysm ◽  
Temporal Artery ◽  
Bypass Patency ◽  
History Of ◽  
End To End

Abstract Large dolichoectatic aneurysms of middle cerebral artery (MCA) trifurcations are rare and often require trapping and revascularization of the region with a bypass.1-9 This video describes the treatment of an MCA trifurcation aneurysm by clip trapping and double-barrel superficial temporal artery (STA) to M2-MCA bypass followed by M2-M2 end-to-end reimplantation to create a middle communicating artery (MCoA). The patient, a 60-yr-old woman, presented with headache, a history of smoking, and a family history of ruptured aneurysms. Angiography demonstrated a 1.7-cm dolichoectatic aneurysm of the MCA trifurcation. While the natural history of these lesions is unclear, the aneurysm size and family history of aneurysmal subarachnoid hemorrhage were factors in proceeding with treatment. Informed written consent was obtained from the patient and her family.  The STA branches were harvested microsurgically, a pterional craniotomy was performed, and the aneurysm was exposed through a transsylvian approach. The two STA branches were anastomosed end-to-side to the middle and inferior trunks of the MCA. Due to the significant mismatch between the donor and recipient vessel calibers, we were concerned that the donors might provide insufficient flow in isolation. Therefore, we decided to transect both M2 trunks from the aneurysm, proximal to the inflow of the bypass, and reimplant them end-to-end. This reimplantation created an MCoA, allowing the two donor arteries to supply the new communication between the inferior and middle trunks, redistributing blood flow through the MCoA according to cerebral demand.  Bypass patency and aneurysm obliteration were confirmed on postoperative angiography. At the 6-mo follow-up, the patient's modified Rankin Scale (mRS) score was 0. The MCoA is a novel construct that, like natural communicating arteries, redistributes flow in response to shifting demand, without the need for additional ischemia time during the bypass. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Image-Guided Surgery for Treatment of Unruptured Middle Cerebral Artery Aneurysms

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONS266-ONS272 ◽  
Author(s):  
Young-Je Son ◽  
Dae Hee Han ◽  
Jeong Eun Kim
Keyword(s):  
Minimally Invasive ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Image Guidance ◽  
Invasive Technique ◽  
Surgical Clipping ◽  
Guided Surgery ◽  
Image Guided ◽  
Mca Aneurysm ◽  
Middle Cerebral Artery Aneurysms

Abstract Objective: Direct surgical clipping appears to be an efficient means for managing unruptured middle cerebral artery (MCA) aneurysms, owing to several angioanatomic features. Here, we present a minimally invasive technique that uses navigation guidance for the treatment of unruptured MCA aneurysms. Methods: Between July of 2003 and June of 2005, we used image-guidance navigation to operate on 24 patients who were diagnosed with unruptured MCA aneurysm. Five men and 19 women were included in the study, and their ages ranged from 43 to 70 years (mean, 58 yr). We predetermined the transsylvian trajectory toward the aneurysm and planned a tailored craniotomy for each patient. Results: All aneurysms were readily identified and successfully clipped via craniotomies of less than 3 cm in diameter. We experienced no surgical complications, and each patient had an uneventful postoperative course. Conclusion: With the aid of navigation, we were able to easily locate MCA aneurysms and perform minimally invasive surgeries such as mini-craniotomies, tailored sylvian dissections, and successful clippings of unruptured MCA aneurysms. In addition, we obtained satisfactory cosmetic results.

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