Reconstruction Options for Complex Middle Cerebral Artery Aneurysms

Sekhar, Laligam N.; Štimac, Dinko; Bakir, Abdurrahman; Rak, Ramin

doi:10.1227/01.neu.0000144210.44405.e0

Cited by 35 publications

(19 citation statements)

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“…In the earlier publications, including 5 or more cases of complex MCA aneurysms treated with the combination of bypass and vessel occlusion, the treatment-related mortality rates vary from 0% to 11% and morbidity from 4.9% to 50% 2,19,23,31,34,[36][37][38]46 (Table 6). Kalani et al 23 published a series of 16 giant MCA aneurysms treated with EC-IC bypass and vessel occlusion.…”

Section: Discussionmentioning

confidence: 99%

“…The complete aneurysm obliteration rate was not reported clearly. Sekhar et al 36 published a series of 7 complex MCA aneurysm cases with different reconstructive solutions, including direct branch reimplantation and various arterial interposition grafts, with excellent results (100% aneurysm obliteration rate, no mortality, 14% morbidity). Similar reconstructive techniques and IC-IC bypasses were described in a few larger series of cases of various complex cerebral aneurysms, including treatment of 9, 2 5, 31 and 16 34 MCA aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…Several modifications of this treatment modality have been described, including extracranialintracranial (EC-IC) or intracranial-intracranial (IC-IC) bypass or more refined revascularization methods, such as in situ bypass or various vascular reconstructions, in combination with total or partial trapping of the aneurysm by means of parent artery occlusion. 21,23,24,31,34,[36][37][38]46 So far, only small series of MCA aneurysms treated with a combination of bypass and parent vessel sacrifice have been described. We report our experience in 24 complex MCA aneurysm cases treated with an EC-IC or IC-IC bypass followed by partial or complete parent vessel occlusion.…”

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confidence: 99%

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Bypass surgery for complex middle cerebral artery aneurysms: impact of the exact location in the MCA tree

Kivipelto

Niemelä

Meling

et al. 2014

JNS

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Object The object of this study was to describe the authors' institutional experience in the treatment of complex middle cerebral artery (MCA) aneurysms necessitating bypass and vessel sacrifice. Methods Cases in which patients with MCA aneurysms were treated with a combination of bypass and parent artery sacrifice were reviewed retrospectively. Results The authors identified 24 patients (mean age 46 years) who were treated with bypass and parent artery sacrifice. The aneurysms were located in the M1 segment in 7 patients, MCA bifurcation in 8, and more distally in 9. The mean aneurysm diameter was 30 mm (range 7–60 mm, median 26 mm). There were 8 saccular and 16 fusiform aneurysms. Twenty-one extracranial-intracranial and 4 intracranial-intracranial bypasses were performed. Partial or total trapping (only) of the parent artery was performed in 17 cases, trapping with resection of aneurysm in 3, and aneurysm clipping with sacrifice of an M2 branch in 4. The mean follow-up period was 27 months. The aneurysm obliteration rate was 100%. No recanalization of the aneurysms was detected during follow-up. There was 1 perioperative death (4% mortality rate) and 6 cerebrovascular accidents, causing permanent morbidity in 5 patients. The median modified Rankin Scale score of patients with an M1 aneurysm increased from 0 preoperatively to 2 at latest follow-up, while the score was unchanged in other patients. Most of the permanent deficits were associated with M1 aneurysms. Twenty-one patients (88%) had good outcome as defined by a Glasgow Outcome Scale score of 4 or 5. Conclusions Bypass in combination with parent vessel occlusion is a useful technique with acceptable frequencies of morbidity and mortality for complex MCA aneurysms when conventional surgical or endovascular techniques are not feasible. The location of the aneurysm should be considered when planning the type of bypass and the site of vessel occlusion. Flow alteration by partial trapping may be preferable to total trapping for the M1 aneurysms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Bypass surgery for complex middle cerebral artery aneurysms: impact of the exact location in the MCA tree

Kivipelto

Niemelä

Meling

et al. 2014

JNS

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“…The original Neuroform device was introduced as the first flexible stent made of a nickel-titanium alloy (nitinol) designed for treatment of intracranial wide-necked and fusiform aneurysms. This device has been evaluated in a number of preliminary studies [3, 6, 10, 16-19], demonstrating its efficacy, safety, and satisfactory immediate anatomical results. The largest series of Neuroform stents in the treatment of aneurysms was recently published with excellent results [20], and our experience with over 300 Neuroform stents mirrors this success.…”

Section: Discussionmentioning

confidence: 99%

Initial Experience with Neuroform EZ in the Treatment of Wide-neck Cerebral Aneurysms

et al. 2012

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PurposeStent-assisted coiling allows embolization and parent vessel reconstruction of wide-necked intracranial aneurysms. The Neuroform EZ (Boston Scientific, Fremont, CA, U.S.A.) stent delivery system offers deployment of a Neuroform stent with fewer steps and improved operator control. Initial experience, technical considerations, and treatment outcomes using the Neuroform EZ stent delivery system in combination with coil embolization are reported.Materials and MethodsSeventeen consecutive patients harboring 21 wide-necked saccular cerebral aneurysms were treated with stent reconstruction. Twenty aneurysms were unruptured; one was treated within 24 hours of diagnosis of rupture. Twenty aneurysms were located in the anterior circulation; one was in the posterior circulation. Immediate and six-month post-treatment angiography and clinical assessment were performed.ResultsIn all cases, the stents were delivered and positioned without difficulty in deployment. Technical complications occurred in 4 patients, but none were directly related to the stent delivery system. On immediate post-treatment angiography, 5 of 21 aneurysms showed complete occlusion, 5 of 21 showed residual neck, and 11 of 21 showed residual contrast filling of the aneurysm sac. At six month follow-up, all 17 patients were clinically stable. Angiography of 18 of the aneurysms showed total occlusion in 12, residual neck in 3, and residual aneurysm filling in 3. Retreatment was performed in the three with residual aneurysm.ConclusionThe Neuroform EZ stent system offers improved anchoring and support in stent delivery, which is particularly useful when multiple stents are overlapped to further protect the parent vessel and increase flow diversion away from the aneurysm sac. The only significant problem encountered was coil prolapse, which could be treated with a second stent when necessary. The ease of deployment improves upon the already clinically successful Neuroform design.

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“…Extracranial-intracranial bypass has been repeatedly shown to be a useful tool in the armamentarium of the vascular neurosurgeon (3,13). Extracranial-intracranial revascularization with the STA, radial artery, or SV provides preservation of flow and demonstrates good long-term patency rates.…”

Section: Interposition Grafts and Aneurysmsmentioning

confidence: 99%

Interposition Grafts and Aneurysms

Amenta

Heros

2015

World Neurosurgery

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Reconstruction Options for Complex Middle Cerebral Artery Aneurysms

Abstract: Techniques for middle cerebral artery reconstruction may remain important and useful in the age of endovascular aneurysm treatment.

Cited by 35 publications

References 14 publications

Bypass surgery for complex middle cerebral artery aneurysms: impact of the exact location in the MCA tree

Bypass surgery for complex middle cerebral artery aneurysms: impact of the exact location in the MCA tree

Initial Experience with Neuroform EZ in the Treatment of Wide-neck Cerebral Aneurysms

Interposition Grafts and Aneurysms

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