Remote cerebellar hemorrhage following surgical clipping of an unruptured cerebral aneurysm of the middle cerebral artery

Abstract OBJECTIVE Because of their anatomic configuration, middle cerebral artery (MCA) aneurysms are most often treated with surgical clipping. However, endovascular coil embolization of these aneurysms is an increasingly used alternative. We retrospectively reviewed the anatomic and clinical outcomes of patients with MCA aneurysms who underwent endovascular treatment at our institution. METHODS One hundred fifteen MCA aneurysms in 115 patients (mean age, 55.1 years) were treated by an endovascular technique from April 1990 to March 2007. Forty-eight patients (42%) presented with acute subarachnoid hemorrhage, and 67 patients (58%) had unruptured aneurysms. Fifty-three aneurysms (46%) were small with a small neck, 28 (24%) were small with a wide neck, 22 (19%) were large, and 12 (11%) were giant. RESULTS Angiographic results immediately after embolization showed complete occlusion in 53 aneurysms (46%), a neck remnant in 51 (44%), and incomplete occlusion in 3 (3%). Because of anatomic difficulties, we could not embolize 8 aneurysms (7%). Thirteen patients underwent combined treatment that included endovascular and extracranial-intracranial bypass surgery. Morbidity and mortality rates were 6.9% (8 patients) and 3% (3 patients), respectively. Procedure-related complications were encountered in 10 patients (9%). Seventy patients had long-term follow-up angiograms. Seven aneurysms (10%) were recanalized; all were large or giant. One partially embolized large aneurysm ruptured 13 months after embolization. CONCLUSION In this series, endovascular coil embolization of MCA aneurysms has morbidity and mortality rates comparable to those of conventional surgical clipping. Combined treatment of endovascular and bypass surgery can successfully treat large or giant complex fusiform MCA aneurysms.

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Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

Acta Neurochirurgica ◽

10.1007/s00701-011-1139-6 ◽

2011 ◽

Vol 153 (11) ◽

pp. 2111-2117 ◽

Cited By ~ 40

Author(s):

J. Marc C. van Dijk ◽

Rob J. M. Groen ◽

Mark Ter Laan ◽

Johanna Rinck Jeltema ◽

Jan Jacob A. Mooij ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Surgical Clipping

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Accessory Middle Cerebral Artery Originating from the Posterior Circulation, Presenting with an Occult Ruptured Cerebral Aneurysm: a Case Report—Management of Atypical Subarachnoid Haemorrhage Cases with Rare Vascular Variations

SN Comprehensive Clinical Medicine ◽

10.1007/s42399-021-01086-w ◽

2022 ◽

Vol 4 (1) ◽

Author(s):

Alexandros Blionas ◽

Savvas Melissaris ◽

Christos Zlatanos ◽

Nikolaos Georgakoulias

Keyword(s):

Case Report ◽

Subarachnoid Haemorrhage ◽

Middle Cerebral Artery ◽

Cerebral Aneurysm ◽

Cerebral Artery ◽

Posterior Circulation ◽

Vascular Variations ◽

Accessory Middle Cerebral Artery

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A FORM OF DYSPLASIA OR A FORTUITOUS ASSOCIATION? A CEREBRAL ANEURYSM INSIDE AN ARACHNOID CYST

Neurosurgery ◽

10.1227/01.neu.0000290917.70717.39 ◽

2007 ◽

Vol 61 (3) ◽

pp. E654-E655 ◽

Cited By ~ 4

Author(s):

Marco A. Zanini ◽

Antonio T. de Souza Faleiros ◽

Gilberto Rondinelli ◽

Roberto C. Gabarra ◽

Luiz A. de Lima Resende

Keyword(s):

Subarachnoid Hemorrhage ◽

Middle Cerebral Artery ◽

Cerebral Aneurysm ◽

Temporal Bone ◽

Arachnoid Cyst ◽

Cerebral Artery ◽

Clinical Presentation ◽

Cranial Vault ◽

Middle Fossa ◽

Intracystic Hemorrhage

Abstract OBJECTIVE Although arachnoid cysts and intracranial aneurysms are very common lesions, their association in the same patient is rare. We present a case of a middle cerebral artery aneurysm ruptured into an arachnoid cyst. We found only six cases with intracystic hemorrhage reported in the literature. The presence of an arachnoid cyst can mislead clinical presentation. The patient presented a paradoxically small temporal fossa and thickening of the temporal and sphenoid bone. The authors suggest that this uncommon association (arachnoid cyst, atypical cranial vault, and “mirror-like” cerebral aneurysm) could represent a form of dysplasia. CLINICAL PRESENTATION A 46-year-old patient presented with a 3-week history of slight headaches, which had worsened in the last 3 days before presentation. Computed tomographic scans showed a cystic lesion located in the middle cranial fossa and sylvian fissure with suspected aneurysm dilation inside. Magnetic resonance imaging scans showed an intracystic hemorrhage but not subarachnoid hemorrhage. Paradoxically, changes in the cranial vault around the cyst were noted. Digital subtraction angiography showed bilateral “mirror” middle cerebral artery aneurysms. INTERVENTION A large right pterional craniotomy was performed with full microsurgical removal of the arachnoid cyst walls and aneurysm clipping. The aneurysm was in the medial wall of the arachnoid cyst with its dome inside the cyst. The contralateral aneurysm was clipped 2 weeks later. The follow-up period was uneventful, and the patient returned to normal life. CONCLUSION Rupture of a cerebral aneurysm into an arachnoid cyst is rare. Clinical presentation may be unusual because the cyst can prevent subarachnoid hemorrhage. A middle fossa cranial arachnoid cyst in the presence of temporal bone depression, small middle fossa, and thickness of squamous temporal bone and the lesser wing of sphenoid is rare and suggests that congenital factors may play an important role in their development. The exceptional association between “mirror” aneurysms and arachnoid cyst with bone changes suggests a possible congenital form of dysplasia.

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Influence of Medial Collagen Organization and Axial In Situ Stretch on Saccular Cerebral Aneurysm Growth

Journal of Biomechanical Engineering ◽

10.1115/1.3200911 ◽

2009 ◽

Vol 131 (10) ◽

Cited By ~ 13

Author(s):

Thomas Eriksson ◽

Martin Kroon ◽

Gerhard A. Holzapfel

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Aneurysm ◽

Cerebral Artery ◽

Collagen Fibers ◽

Circumferential Direction ◽

Thickness Increase ◽

Aneurysm Wall ◽

Aneurysm Growth ◽

The Media

A model for saccular cerebral aneurysm growth, proposed by Kroon and Holzapfel (2007, “A Model for Saccular Cerebral Aneurysm Growth in a Human Middle Cerebral Artery,” J. Theor. Biol., 247, pp. 775–787; 2008, “Modeling of Saccular Aneurysm Growth in a Human Middle Cerebral Artery,” ASME J. Biomech. Eng., 130, p. 051012), is further investigated. A human middle cerebral artery is modeled as a two-layer cylinder where the layers correspond to the media and the adventitia. The immediate loss of media in the location of the aneurysm is taken to be responsible for the initiation of the aneurysm growth. The aneurysm is regarded as a development of the adventitia, which is composed of several distinct layers of collagen fibers perfectly aligned in specified directions. The collagen fibers are the only load-bearing constituent in the aneurysm wall; their production and degradation depend on the stretch of the wall and are responsible for the aneurysm growth. The anisotropy of the surrounding media was modeled using the strain-energy function proposed by Holzapfel et al. (2000, “A New Constitutive Framework for Arterial Wall Mechanics and a Comparative Study of Material Models,” J. Elast., 61, pp. 1–48), which is valid for an elastic material with two families of fibers. It was shown that the inclusion of fibers in the media reduced the maximum principal Cauchy stress and the maximum shear stress in the aneurysm wall. The thickness increase in the aneurysm wall due to material growth was also decreased. Varying the fiber angle in the media from a circumferential direction to a deviation of 10 deg from the circumferential direction did, however, only show a little effect. Altering the axial in situ stretch of the artery had a much larger effect in terms of the steady-state shape of the aneurysm and the resulting stresses in the aneurysm wall. The peak values of the maximum principal stress and the thickness increase both became significantly higher for larger axial stretches.

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