Middle cerebral artery aneurysms: aneurysm angiographic morphology and its relation to pre-operative and intra-operative rupture

Abstract

ARTICLEMiddle cerebral artery aneurysms: aneurysm angiographic morphology and its relation to pre-operative and intra-operative rupture Aneurismas da artéria cerebral média: morfologia angiográfica dos aneurismas e sua relação com ruptura pré-operatória e intra-operatória ABSTRACTObjective: Correlate the middle cerebral artery bifurcation aneurysm morphology with the pre-operative and intra-operative risk of rupture. Methods: Forty patients with 46 middle cerebral artery bifurcation aneurysms were treated microsurgically by the same surgeon. Aneurysms were classified according to shape and the Fisher test was applied to analyze the effect of morphology on the pre-operative and intra-operative rupture. Results: Pre-operative and intra-operative ruptures were observed in 8/46 patients (17.4%) and 14/46 patients (30.4%) respectively. Thirty-two cases (69.6%) had no symptoms postoperatively, modified Rankin score (MRS) of 0; 6.5% had MRS of 1 (no significant disability); 13% had MRS of 2 (slight disability); 4.3% had moderately severe disability (MRS of 4); and there were 3 deaths (6.5%) post-operatively. The morphology was not directly related to the rupture rate. Conclusion: In general, ruptures are not affected by the morphology or the studied variables. Larger series are needed to validate these outcomes.Keywords: aneurysm; subarachnoid hemorrhage; middle cerebral artery. RESUMOObjetivo: Correlacionar a morfologia do aneurisma da bifurcação da artéria cerebral média com o risco de ruptura pré-operatória e intraoperatória. Métodos: 40 pacientes com 46 aneurismas de bifurcação da artéria cerebral média receberam tratamento microcirúrgico pelo mesmo cirurgião. Os aneurismas foram classificados de acordo com a morfologia e o teste de Fisher foi aplicado para analisar o efeito da morfologia sobre a ruptura pré-operatória e intra-operatória. Resultados: As rupturas pré e intra-operatória foram observadas em 8/46 pacientes (17,4%) e 14/46 (30,4%) respectivamente. Trinta e dois casos (69,6%) não apresentaram sintomas pós-operatórios, pontuação de Rankin modificada (MRS) de 0, 6,5% tinham MRS de 1 (sem incapacidade significativa), 13% tinham MRS de 2 (leve incapacidade), 4,3% moderadamente grave (MRS de 4) e houve 3 óbitos (6,5%) durante o pós-operatório. A morfologia não estava diretamente relacionada à taxa de ruptura pré-operatória ou intra-operatória. Conclusão: Em geral, as rupturas não são afetadas pela morfologia ou pelas variáveis estudadas. São necessárias séries maiores para validar esses resultados.Palavras-chave: aneurisma; hemorragia subaracnoidea; artéria cerebral média.

A case report on middle cerebral artery aneurysm treated by rapid ventricular pacing

“…[14] The intracranial aneurysm is mainly managed surgically by coil embolism or clipping. However, surgery itself is a risk factor for aneurysm rupture, [15] and the rupture can occur in any stage of surgery. The size of aneurysm, the thickness of blood vessel wall, and BP are important factors to predict the risk of intraoperative rupture of aneurysm.…”

Endovascular treatment of small (< 5 mm) unruptured middle cerebral artery aneurysms

“…Middle cerebral artery (MCA) aneurysms account for 18-22% of all intracranial aneurysms and are the third most common location for aneurysmal subarachnoid haemorrhage [1,2]. In the case of small unruptured MCA aneurysms, the indication for treatment should be made carefully because the risk of rupture of these lesions is very low [3].…”