Middle Cerebral Artery Bifurcation Aneurysms

Washington, Chad W.; Ju, Tao; Zipfel, Gregory J.; Dacey, Ralph G.

doi:10.1227/neu.0000000000000250

Cited by 14 publications

(8 citation statements)

References 25 publications

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“…Observations Despite the present endovascular era, microsurgical clip ligation remains the mainstay for MCA aneurysms because of their specific morphological characteristics, such as a wide neck and asymmetrical branches that are incorporated into the aneurysm neck. [5][6][7][8] When performing clip ligation, superiorly projecting aneurysms arising from the M1 segment represent one of the most complicated aneurysms, requiring dissection of the LSA from the aneurysm to avoid postoperative morbidities. 1,4 Although most of these aneurysms can be exposed by meticulous dissection of the sylvian fissure, some of the aneurysms cannot be sufficiently dissected if they are encased in a sulcus-like structure (mean width 15 mm), referred to as the "limen recess," between the medial border of the limen insulae and the lateral limit of the anterior perforating substance.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of partial resection of the anterior insular cortex for microsurgical treatment of middle cerebral artery aneurysms located in the limen recess: patient series

Akamatsu

Kashimura

Fujiwara

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND When performing clip ligation of superior projecting aneurysms of the proximal (M1) segment of the middle cerebral artery (MCA), meticulous sylvian fissure dissection alone may be inadequate for safe clip application, especially in cases in which the aneurysm is buried in the limen recess, since the limen insulae may be positioned lateral to the aneurysm. In the present patient series, the authors present their surgical technique for clip ligation of aneurysms located in the limen recess, with partial resection of the limen insulae. OBSERVATIONS A retrospective analysis of patients who had undergone clip ligation of MCA aneurysms located at the limen recess at a single institute was performed. Patients with angiographic and clinical follow-up data were considered eligible. A total of 11 aneurysms (4 ruptured and 7 unruptured aneurysms) in 11 patients were evaluated. Postoperative ischemic lesions were observed on images obtained within 1 week after surgery in 5 (45.5%) patients who had undergone partial resection of the limen insulae, although none of them presented with neurological deterioration. LESSONS Partial resection of limen insulae may be feasible to avoid severe ischemic complications following clip ligation of M1 aneurysms embedded in the limen recess.

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Section: Discussionmentioning

confidence: 99%

Feasibility and safety of partial resection of the anterior insular cortex for microsurgical treatment of middle cerebral artery aneurysms located in the limen recess: patient series

Akamatsu

Kashimura

Fujiwara

et al. 2021

Journal of Neurosurgery: Case Lessons

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“…[1][2][3][4][5][6][7][8][9][10][11] Various classifications for MCA aneurysms were suggested based on their neck anatomy, progression of the pathological thin wall into the surrounding vessels, parent vessel geometry, or direction of the dome projection. 2,11,12,[16][17][18][19] Outflow vessel size and orientation and neck anatomy can be variable and complex and thus lead to several standardized approaches to clipping based on morphological characteristics. 2,12,16,17,[29][30][31] Our data suggest that another feature that leads to significant complexity of safe treatment is the amount of aneurysm that extends proximal to the 2 dimensionally defined neck.…”

Section: Discussionmentioning

confidence: 99%

“…2,11,12,[16][17][18][19] Outflow vessel size and orientation and neck anatomy can be variable and complex and thus lead to several standardized approaches to clipping based on morphological characteristics. 2,12,16,17,[29][30][31] Our data suggest that another feature that leads to significant complexity of safe treatment is the amount of aneurysm that extends proximal to the 2 dimensionally defined neck. In aneurysms with large neck overhang, any clipping strategy that places a clip parallel to the outflow vessels further widens the splayed bifurcation and risks kinking or stenosis of these vessels (see Figure 5).…”

Section: Discussionmentioning

confidence: 99%

“…Such a standard approach to clipping is valuable given that, in the era of endovascular treatment, surgical treatment of aneurysms has significantly declined, leading to a decrease of surgical exposure of young neurosurgeons. 17,[41][42][43] As a result, less experienced neurosurgeons face difficulties with mastering disparate, complex clipping techniques for anatomically different aneurysms. The intersecting clipping technique is straightforward and versatile as a first-line clipping strategy for most MCA aneurysms and almost all aneurysms with neck overhang >1.9 mm.…”

Section: Clipping Techniquementioning

confidence: 99%

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Middle Cerebral Artery Aneurysm “Neck Overhang”: Decreased Postclipping Residual Using the Intersecting Clipping Technique

Dimitriadis

Qeadan

Taylor

et al. 2018

ONSURG

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“…But for the treatment of bifurcation and complex aneurysms, there is still beneficial to the complete clipping of these aneurysms neck surfaces by craniotomy clipping [5,6]. The space configuration of the aneurysm neck curved surface should be taken into consideration when clipping the neck of the aneurysm [7][8][9][10]. The residual neck of aneurysm is one of the most common causes of aneurysm recurrence, residual aneurysm neck is affected by many factors including aneurysm clip selection, placement and combination, resulting in residual and recurrent aneurysms, and controllable factors in most hospital department of neurosurgery physicians only who has clinical experience and surgical skills can provide the equipment support [11,12].…”

Section: Introductionmentioning

confidence: 99%

The classification of intracranial aneurysm neck: a single center research experience

Huang

Kang

et al. 2018

Chin Neurosurg Jl

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Background: There is associating with incidence of unfavorable outcomes compared to microsurgical clippings. We are in order to investigate the outcomes of microsurgical clipping for intracranial aneurysms and determine the ideal clipping methods for different aneurysm subtypes.Method: Retrospectively analyzed the clinical characteristics and follow-up data (completely recorded) of 123 patients with 128 aneurysms were treated. 20 cases were treated as control group from , aneurysms were classified base on the 20 cases of aneurysm imaging data. 103 patients were treated as experimental group, the classification of aneurysms previously proposed was used to estimate the way of surgery, and the guiding value of the genotype was verified according to the intraoperative findings. The proposed aneurysm classification is based on the virtual surface of the aneurysm and the parent artery, the aneurysm neck was classified as follows: subtype I, the curved surface of the neck is a single curved surface; subtype II, the neck is hyperboloid; subtype III, neck is a three-curved surface. Aneurysms were divided into further subtypes according to the ratio of the width of the aneurysm neck surface and the length of the artery circumference: subtype A, the ratio of the aneurysm neck surface to the parent artery was not more than 0.5; subtype B, more than 0.5. There are some clamping methods include simple, sliding, interlocking and hybrid.Results: In the control group, patients did not undergo a suitable clipping scheme without classification of aneurysm neck (unclassed clipping). While causing the occurrence of occlusion adverse events, including neck residual, Tumor artery stenosis, electrophysiological changes, the lack of blood supply and so on. The experimental[page1image12073600]group was analyzed by using a predetermined clipping scheme (classed clipping), and the use of aneurysms clamps was approximately the same as expected. Compared the preoperative assessment with the actual situation, the consistency of the control group was 50% and the experimental group was 96%. Adverse events of classed clipping is 2%, another is 60%. There is a significant difference between the two groups (P < 0.05).Classed clipping of subject IA and IB are simple (mean 1.2 and 1.3 clips); classed clipping of subject IIA is simple and interlocking(mean 1.2 clips); classed clipping of subject IIB is sliding and hybrid(mean 2.05 clips); classed clipping of subject IIIA and IIIB are hybrid(mean 2.3 clips). Conclusion: There is a higher consistency in surgery through the above classification of preoperative assessment of clipping. There was no adverse event of intracranial aneurysm clipping in the clipping mode selected by the above classification, and satisfactory surgical clipping rate was achieved and no recurrence was found.

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Middle Cerebral Artery Bifurcation Aneurysms

Cited by 14 publications

References 25 publications

Feasibility and safety of partial resection of the anterior insular cortex for microsurgical treatment of middle cerebral artery aneurysms located in the limen recess: patient series

Feasibility and safety of partial resection of the anterior insular cortex for microsurgical treatment of middle cerebral artery aneurysms located in the limen recess: patient series

Middle Cerebral Artery Aneurysm “Neck Overhang”: Decreased Postclipping Residual Using the Intersecting Clipping Technique

The classification of intracranial aneurysm neck: a single center research experience

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