Surgical strategies using cerebral revascularization in complex middle cerebral artery aneurysms

Seo, Bo-Ra; Kim, Tae-Sun; Joo, Sung‐Pil; Lee, Jong-Myong; Jang, Jee-Soo; Lee, Jung Kil; Kim, Jae Hyoo; Kim, Soo Han

doi:10.1016/j.clineuro.2009.06.002

Cited by 45 publications

(24 citation statements)

References 23 publications

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“…A 75% aneurysm obliteration rate was achieved, with 0% mortality and 31% morbidity and excellent or good clinical outcome in 94% of cases. Seo et al 37 reported a 100% aneurysm obliteration rate in a series of 9 complex MCA aneurysms after revascularization followed by excision, clipping, or trapping of the aneurysm; there was an 11% mortality rate and 22% morbidity rate, with 67% rate of favorable clinical outcome. Twenty-two MCA aneurysms were treated with ELANA bypass by van Doormaal et al 46 with 5% perioperative mortality, 36% morbidity, and 77% favorable outcome.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…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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“…Unfortunately, in that respect, most recent publications consist of endovascular series, and site-specific series comparing coiling versus clipping for cerebral aneurysms. 2,4,5,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]27,31,32, While these comparisons between competing techniques are obviously expected to occur, we feel that, as endovascular treatment for aneurysms continues to evolve and find its definite place in the therapeutic armamentarium, its proven benefits are best weighed in a multidisciplinary, complementary approach. We have experienced the benefits of this therapeutic philosophy as the natural evolution of a collaborative approach to these complex lesions from all possible therapeutic approaches to improve our patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Treatment Strategies for Complex Intracranial Aneurysms: Review of a 10-Year Experience at the University of Cincinnati

Andaluz¹,

Zuccarello²

2009

Skull Base

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Complex intracranial aneurysms (CIAs) include those classified as giant, those located in brain regions of technically difficult access, or that involve arterial trunks/ branches, and/or have complicated wall structure. We reviewed retrospectively our management of such lesions in a 12-year period. From 1997From to 2009 patients were admitted with CIAs (133 females, 59 males; average age 55 years); 128 presented with subarachnoid hemorrhage (SAH) and 64 with unruptured, symptomatic CIAs. The SAH group had 73 anterior-and 55 posterior-circulation aneurysms. Most frequent location was middle cerebral artery. Treatment strategies included clipping (65.6%), coiling/stenting (28.1%), bypass (3.1%), no treatment (3.1%). Coiling/stenting was exclusively used for posterior-circulation aneurysms. Outcomes were good (modified Rankin Scale [mRS] 0 to 2) in 54 patients (42.2%), fair (mRS ¼ 3 to 4) in 38 (29.7%), and poor (mRS ¼ 5 to 6) in 36 (28.1%). Among unruptured CIAs, there were 47 anterior-and 17 posterior-circulation aneurysms. Most frequent location was ophthalmic. Thirty (46.9%) were clipped, 19 (29.7%) coiled, 6 (9.4%) by-passed, 2 (3.1%) wrapped, and 7 (10.9%) had no treatment. Outcomes were good in 57 patients (89%) and fair in 7 (11%). Good outcomes were obtained in unruptured CIAs using a multidisciplinary approach. Ruptured CIAs carry a significantly worse prognosis than overall SAH patients.

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“…[1][2][3][4][5][6][7][8][9][10][11][12] In the majority of cases, procedures are performed using an extracranial artery as a donor artery with or without interposition graft (extracranial-intracranial bypass). 1,4,5,7,[9][10][11] We encountered a case in which intracranial-intracranial bypass appeared preferable, given the anatomical configuration and operative approach employed, which may support the concept that intracranial-intracranial bypass may represent an advanced form of vascular reconstruction that is effective in selected patients. 8) …”

Section: Introductionmentioning

confidence: 99%

Middle Cerebral-Anterior Cerebral-Radial Artery Interposition Graft Bypass for Proximal Anterior Cerebral Artery Aneurysm -Case Report-

Kazumata

Asaoka

Yokoyama

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 74-year-old man underwent pterional craniotomy to treat a left proximal anterior cerebral artery (ACA) aneurysm. The orifice of the aneurysm was located at the origin of the proximal segment of the ACA, and the right A 1 segment of ACA was hypoplastic. After failed attempts at neck plasty with fenestrated clips, trapping and bypass were performed. Superficial temporal to left frontopolar artery bypass was performed to secure minimal blood supply. The radial artery (RA) was then harvested, and middle cerebral artery (MCA) to A 1 segment of the ACA bypass was performed using the RA interposition graft. Trapping of the aneurysm was successfully achieved without ischemic event. Intracranial-intracranial bypass has been employed in the treatment of complex cerebral aneurysm in an increasing number of selected patients. The present case shows that MCA-ACA-RA interposition graft bypass is an effective procedure to provide blood supply to the ACA territory if a proximal A 1 lesion requires trapping with incompetent contralateral A 1 .

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Surgical strategies using cerebral revascularization in complex middle cerebral artery aneurysms

Cited by 45 publications

References 23 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

Treatment Strategies for Complex Intracranial Aneurysms: Review of a 10-Year Experience at the University of Cincinnati

Middle Cerebral-Anterior Cerebral-Radial Artery Interposition Graft Bypass for Proximal Anterior Cerebral Artery Aneurysm -Case Report-

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