Surgical Management of Ruptured Middle Cerebral Artery Aneurysms With Large Intraparenchymal or Sylvian Fissure Hematomas

Stapleton, Christopher J.; Walcott, Brian P.; Fusco, Matthew R.; Butler, William E.; Thomas, Ajith J.; Ogilvy, Christopher S.

doi:10.1227/neu.0000000000000596

Cited by 28 publications

(15 citation statements)

References 36 publications

(36 reference statements)

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“…A separate and often-cited advantage of microsurgical clipping of ruptured MCA aneurysms is the ability to evacuate an IPH or perform a decompressive hemicraniectomy promptly in the same surgical setting. 18,20,23 In our series, one-half of the 46 patients had IPH associated with aneurysm rupture, and 7 (14%) of them required a decompressive craniotomy. Notably, in the series of endovascularly treated ruptured MCA aneurysms by Mortimer et al, 14 8.2% (20 of 244) of patients underwent surgery for IPH evacuation or decompressive craniotomy after endovascular treatment of the aneurysm.…”

Section: Discussionmentioning

confidence: 64%

Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

Mooney¹,

Simon²,

Brigeman³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE A direct comparison of endovascular versus microsurgical treatment of ruptured middle cerebral artery (MCA) aneurysms in randomized trials is lacking. As endovascular treatment strategies continue to evolve, the number of reports of endovascular treatment of these lesions is increasing. Herein, the authors report a detailed post hoc analysis of ruptured MCA aneurysms treated by microsurgical clipping from the Barrow Ruptured Aneurysm Trial (BRAT). METHODS The cases of patients enrolled in the BRAT who underwent microsurgical clipping for a ruptured MCA aneurysm were reviewed. Characteristics of patients and their clinical outcomes and long-term angiographic results were analyzed. RESULTS Fifty patients underwent microsurgical clipping of a ruptured MCA aneurysm in the BRAT, including 21 who crossed over from the endovascular treatment arm. Four patients with nonsaccular (e.g., dissecting, fusiform, or blister) aneurysms were excluded, leaving 46 patients for analysis. Most (n = 32; 70%) patients presented with a Hunt and Hess grade II or III subarachnoid hemorrhage, with a high prevalence of intraparenchymal blood (n = 23; 50%), intraventricular blood (n = 21; 46%), or both. At the last follow-up (up to 6 years after treatment), clinical outcomes were good (modified Rankin Scale score 0-2) in 70% (n = 19) of 27 Hunt and Hess grades I-III patients and in 36% (n = 4) of 11 Hunt and Hess grade IV or V patients. There were no instances of rebleeding after the surgical clipping of aneurysms in this series at the time of last clinical follow-up. CONCLUSIONS Microsurgical clipping of ruptured MCA aneurysms has several advantages over endovascular treatment, including durability over time. The authors report detailed outcome data of patients with ruptured MCA aneurysms who underwent microsurgical clipping as part of a prospective, randomized trial. These results should be used for comparison with future endovascular and surgical series to ensure that the best results are being achieved for patients with ruptured MCA aneurysms.

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Section: Discussionmentioning

confidence: 64%

Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

Mooney¹,

Simon²,

Brigeman³

et al. 2019

Journal of Neurosurgery

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“… 16 Recent studies have indicated that simultaneous hematoma evacuation and aneurysmal clipping with or without craniectomy can be an effective treatment modality for poor-grade middle cerebral artery aneurysms. 17 Along with the advances in microneurosurgical techniques and development of microneurosurgical instrumentation, “keyhole” (mini bone flap) approach has been applied to aneurysmal clipping, and be equally likely to obtain a good outcome. 18 Furthermore, external ventricular drainage (EVD) could reduce the intracranial pressure and has been proved to be indicative of increased likelihood favorable outcome for poor-grade aneurysms.…”

Section: Introductionmentioning

confidence: 99%

Keyhole Approach Combined With External Ventricular Drainage for Ruptured, Poor-Grade, Anterior Circulation Cerebral Aneurysms

Zheng

Yao²,

Yu³

et al. 2015

Medicine

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“…Vascular malformations that can lead to SICH include arteriovenous malformations (23), cerebral aneurysms (24), dural arteriovenous fistulas (25), and cavernous malformations (26). Patients who have had ischemic strokes can experience hemorrhagic conversion (27), as can up to 50% of cerebral venous thrombosis patients (28).…”

Section: Sich Etiologymentioning

confidence: 99%

Targeting Secondary Hematoma Expansion in Spontaneous Intracerebral Hemorrhage – State of the Art

Guan

Hawryluk

2016

Front. Neurol.

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Spontaneous intracerebral hemorrhage (SICH), defined broadly as intracerebral hemorrhage not related to trauma, results in long-term disability or death in a large proportion of afflicted patients. Current management of this disease is predominantly supportive, including airway protection, optimization of hemodynamic parameters, and management of intracranial pressure. No active treatments that demonstrate beneficial effects on clinical outcome are currently available. Animal models of SICH have allowed for the elucidation of multiple pathways that may be attractive therapeutic targets. A minority of these, such as aggressive blood pressure management and recombinant activated factor VII administration, have led to large-scale clinical trials. There remains a critical need for further translational research in the realm of SICH.

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Surgical Management of Ruptured Middle Cerebral Artery Aneurysms With Large Intraparenchymal or Sylvian Fissure Hematomas

Abstract: MCA aneurysm rupture with concomitant large intraparenchymal or sylvian fissure hematoma formation carries a grave prognosis. Simultaneous hematoma evacuation and aneurysm clipping with or without craniectomy can be an effective treatment modality.

Cited by 28 publications

References 36 publications

Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

Keyhole Approach Combined With External Ventricular Drainage for Ruptured, Poor-Grade, Anterior Circulation Cerebral Aneurysms

Targeting Secondary Hematoma Expansion in Spontaneous Intracerebral Hemorrhage – State of the Art

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