Prognostic factors of ruptured middle cerebral artery aneurysms treated with surgical clipping

Background: Spontaneous subarachnoid haemorrhage is an emergent condition that leads to profound morbidity and mortality. It is mainly caused by a ruptured intracranial aneurysm. Herein we described the relationship of different factors and their impact on the outcome of patients who underwent a surgical clipping exclusively to the ruptured middle cerebral artery aneurysm. Methods: We retrospectively analyzed the medical records of patients admitted to the Neurosurgery Teaching Hospital (NTH) in Baghdad for the period between January 2017-April 2019 of patients who underwent microsurgical clipping for ruptured middle cerebral artery aneurysm. Demographic, clinical, radiological and surgical data were extracted. A univariate analysis was used to illustrate the relationship between the variables and outcome which was assessed using the five scores of the Glasgow Outcome Scale where patients were dichotomized into two groups; favourable (IV + V) and unfavourable (I, II, III). Results: Within this cohort, a total of 50 patients were studied and the analysis revealed that 92% (N=46) had a favourable outcome and 8% (N=4) had an unfavourable outcome at discharge. The in-hospital mortality was 6%(N=3). Factors that were significantly associated with poor outcome were giant aneurysms, the presence of other unruptured aneurysms, post-operative clinical vasospasm, presence of contralateral weakness, lower pre/post-operative Glasgow coma scores, higher Hunt and Hess, World Federation of Neurosurgical Societies (WFNS) and modified-WFNS grades. Conclusion: The factors with a significant impact on the outcome of patients with surgically clipped ruptured middle cerebral artery aneurysms were GCS, WFNS, m-WFNS, H&H, contralateral muscle weakness, size of the aneurysm, presence of other unruptured aneurysms and clinical vasospasm.

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Surgical clipping of a large left middle cerebral artery aneurysm

Neurosurgical FOCUS ◽

10.3171/2015.v1.focus14555 ◽

2015 ◽

Vol 38 (videosuppl1) ◽

pp. Video13

Author(s):

M. Yashar S. Kalani ◽

Peter Nakaji ◽

Joseph M. Zabramski ◽

Robert F. Spetzler

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Artery Aneurysm ◽

Left Middle Cerebral Artery ◽

Middle Cerebral Artery Aneurysm ◽

Surgical Clipping ◽

Microsurgical Clipping ◽

Middle Cerebral Artery Aneurysms ◽

Cerebral Artery Aneurysm ◽

Left Middle

Middle cerebral artery aneurysms, especially those with complex morphology, are considered excellent aneurysms for surgical clipping, given the challenges that exist with current endovascular techniques. We present a case of a large, complex, left middle cerebral artery aneurysm treated with microsurgical clipping. This video highlights critical steps in obtaining proximal and distal control as well as subarachnoid dissection necessary to prepare the aneurysm for final clipping.The video can be found here: http://youtu.be/RlKH2Km9z5Y.

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Growth and Spontaneous Regression of a Middle Cerebral Artery Aneurysm after Surgical Clipping

Interventional Neuroradiology ◽

10.1177/159101990100700210 ◽

2001 ◽

Vol 7 (2) ◽

pp. 147-151 ◽

Cited By ~ 1

Author(s):

C.B. Tan ◽

G. Rodesh ◽

P. Lasjaunias

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Spontaneous Regression ◽

Artery Aneurysm ◽

Middle Cerebral Artery Aneurysm ◽

Surgical Clipping ◽

Complete Obliteration ◽

Grade Ii ◽

Partial Thrombosis ◽

Cerebral Artery Aneurysm

We present a case of growth and spontaneous regression of a middle cerebral artery aneurysm after surgical clipping. A 36-year-old woman who presented with grade II subarachnoid haemorrhage was found to have a right middle cerebral artery aneurysm. The aneurysm was surgically clipped in view of the morphology of the aneurysm. Second clipping was performed four months later as there was re-growth of the neck of the aneurysm. Again re-growth of the aneurysm was noted five months after the second clipping. As further clipping of the aneurysm would be difficult, external and internal carotid arteries bypass was the treatment option but unfortunately, the by-pass operation was unsuccessful. Interestingly, angiogram performed after the bypass surgery revealed partial thrombosis and decreasing size of the aneurysm. Complete obliteration of the aneurysm was noted without further intervention one month after the failed by-pass surgery.

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Middle cerebral artery aneurysm surgery after stent misplacement: A case report

Interventional Neuroradiology ◽

10.1177/1591019915617313 ◽

2015 ◽

Vol 22 (1) ◽

pp. 49-52 ◽

Cited By ~ 1

Author(s):

Abdul Rahman Al-Schameri ◽

Manuel Lunzer ◽

Cornelia Daller ◽

Michael Kral ◽

Monika Killer

Keyword(s):

Case Report ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Artery Aneurysm ◽

Aneurysm Surgery ◽

Middle Cerebral Artery Aneurysm ◽

Surgical Clipping ◽

Increased Risk ◽

Mca Aneurysm ◽

Cerebral Artery Aneurysm

Stent misplacement during endovascular treatment of middle cerebral artery (MCA) aneurysms can cause challenges and be problematic, if clipping becomes necessary. This article reports on a 56-year-old woman with an unruptured, multi-lobulated MCA aneurysm, whom primarily refused surgery; therefore, she was scheduled for stent-assisted coiling. After successful deployment of the stent, it unfortunately then became snagged by the microcatheter and was pulled backwards. The subsequent surgical procedure (i.e. clipping of the MCA aneurysm) was challenging, due to the position of the dislodged stent. Such as misplacement of the stent is rarely documented: It resulted in the difficult handling of a MCA aneurysm. Aneurysms of the MCA should primarily be considered for surgical clipping. In conclusion, an increased risk for eventual surgery should be considered, in cases where endovascular treatments with stents are performed.

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Technical nuances of clipping a middle cerebral artery bifurcation aneurysm

Neurosurgical FOCUS ◽

10.3171/2015.7.focusvid.14568 ◽

2015 ◽

Vol 39 (videosuppl1) ◽

pp. V2

Author(s):

Piyush Kalakoti ◽

Shyamal C. Bir ◽

Richard D. Murray ◽

Osama Ahmed ◽

Anil Nanda

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Artery Aneurysm ◽

Middle Cerebral Artery Aneurysm ◽

Postoperative Course ◽

Microsurgical Clipping ◽

Bifurcation Aneurysm ◽

Middle Cerebral Artery Aneurysms ◽

Intraoperative Rupture ◽

Cerebral Artery Aneurysm

Broad-necked middle cerebral artery aneurysms present unique challenges for the vascular neurosurgeon, who must contend with smaller vessels and often a complex clipping strategy. Due to their superficial location, these lesions are still commonly selected for microsurgical clipping. We present a case of a 42-year-old woman with significant vascular disease with a right middle cerebral artery aneurysm. We discuss the key surgical steps, demonstrate the microsurgical dissection and intraoperative rupture encountered and the final clipping strategy, as well as the postoperative course in this operative video presentation.The video can be found here: http://youtu.be/qZ2gvqz7XdQ.

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