Surgical Treatment of Middle Cerebral Artery Aneurysms: Aneurysm Location and Size Ratio as Risk Factors for Neurologic Worsening and Ischemic Complications

Matsukawa, Hidetoshi; Kamiyama, Hiroyasu; Miyazaki, Takanori; Kinoshita, Yu; Ota, Nakao; Noda, Kosumo; Shonai, Takaharu; Takahashi, Osamu; Tokuda, Sadahisa; Tanikawa, Rokuya

doi:10.1016/j.wneu.2018.06.077

Cited by 11 publications

(9 citation statements)

References 21 publications

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“…Previous studies have indicated that favorable outcomes can generally be achieved in cases involving clipping of MCA aneurysms if the aneurysm is not large or if the patient is not very old. 12 However, Matsukawa et al 5 reported that middle cerebral artery territory infarctions were observed more frequently in early frontal cerebral branch MCA aneurysms by clipping (OR: 3.8 95% CI: 1.2-12). Additionally, they reported that middle cerebral artery territory infarctions affect neurologic worsening after 30 days from the operation.…”

Section: Discussionmentioning

confidence: 98%

“…Previous studies have shown that infarctions of the middle cerebral artery territory may occur when clipping aneurysms of the frontal cerebral branch. 5 Usually, clipping of aneurysms of the proximal MCA is difficult because the origin of the lenticulostriate arteries (LSA) is often hidden behind the dome and is usually attached to the dome, requiring dissection of the perforators. 6 In the present study, we aimed to investigate the results of endovascular coil embolization in MCA aneurysms and the morphological characteristics at each location.…”

Section: Introductionmentioning

confidence: 99%

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Endovascular coil embolization of proximal middle cerebral artery aneurysms has better outcomes than other middle cerebral artery aneurysms: A retrospective study

et al. 2020

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Purpose Although some authors proposed that coil embolization in middle cerebral artery (MCA) aneurysms is a useful and effective alternative, the characteristics of the aneurysms may be different at each location. We compared the results of coil embolization of proximal middle cerebral artery aneurysms with those of other middle cerebral artery aneurysms. Methods Data from 46 patients with 50 aneurysms were retrospectively evaluated. We defined the aneurysms inside of the insular cortex as proximal MCA (pMCA) aneurysms and those outside of the insular cortex as non-proximal MCA (npMCA) aneurysms. The results of the occlusion were divided into classes 1, 2, and 3 of the Raymond scale. We collected the results of the occlusion from the operative notes supplied by a neuroendovascular specialist. Results Univariate analysis identified favorable results for pMCA aneurysms (class 1: pMCA = 22 npMCA = 11; P < 0.01). In the radiological follow-up results, we achieved class 1 in 29 patients (69%; pMCA = 21 and npMCA = 8; P < 0.01). Side wall type aneurysms (pMCA = 14, npMCA = 2; P < 0.01) and the number of branches from the neck of ≤1 (pMCA = 14, npMCA = 2; P < 0.01) were significantly recognized at the pMCA. Conclusions Proximal middle cerebral artery aneurysm clipping is difficult because the origin of the lenticulostriate arteries is often hidden behind the aneurysmal dome. In the present study, endovascular coil embolization for pMCA aneurysms obtained better results than that for npMCA aneurysms because of the morphological characteristics. Endovascular coil embolization seems to be efficacious for pMCA aneurysms as compared with npMCA aneurysms.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Endovascular coil embolization of proximal middle cerebral artery aneurysms has better outcomes than other middle cerebral artery aneurysms: A retrospective study

et al. 2020

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“…These findings contrast with those reported in the international medical literature, where the planning of surgical approach is performed only with images obtained from the contrasted two-dimensional (2D) study, observing an incidence of intraoperative complications between 12 and 20%. 8,14,[16][17][18][19][20][21][22][23][24] We observed that with the 3D-CTA, 360-degree reconstruction offered an additional advantage, which consists in the possibility of eliminating brain mass, bone, and vascular structures that have allowed us to perform a preoperative virtual reality surgical approach and after apply it in real-time surgery, with successful results in cerebral aneurysm clipping, as well as the teaching of this virtual technique in the cerebrovascular training program, for neurosurgeons.…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Virtual Reality Simulation to Safe Planning Neurosurgical Procedure in Brain Aneurysms, Latin American Single-Center Experience: Advantages and Limitations

Zarate-Mendez

Ramos-Delgado

Lujan-Guerra

et al. 2021

Indian Journal of Neurosurgery

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Background The neurosurgical approach to clipping cerebral aneurysms has been a complex challenge for all neurosurgeon experts in cerebrovascular surgery. The three-dimensional computed tomography angiography (3D-CTA) allows identifying bone and vascular structures close to an aneurysm to simulate in virtual 3D images, the appropriate and safest approach to cerebral aneurysm clipping. Objectives This study aims to share our experience using 3D simulation as a support to the safe planning for cerebrovascular disease surgery. Materials and Methods We reviewed the surgical outcomes from a cerebrovascular neurosurgeon using the 3D-CTA images in 360-degree reconstruction in the planning of the preoperative surgical procedure for the treatment of brain aneurysm. In all patients, the virtual surgical approach was replicated in real-time surgery. Results We analyzed 34 patients around 51 ± 8 years of age. Of these, 76.5% (n = 26) and 23.5% (n = 8) were males and females, respectively. Saccular aneurysms were the most frequent (85%), the Arteries affected by aneurysms were middle cerebral artery (n = 6), basilar tip (n = 6), vertebral artery in V3 and V4 (n = 6), and posterior cerebral artery (n = 5). The virtual surgical pterional approach was the most frequently used (50%), followed by fronto-orbito-zigomático (29%) and far lateral (15%) approaches. There were no intraoperative complications in any patient. Conclusion Preoperative 3D virtual reality simulation is a great support tool to perform a safe surgical procedure in real-time for the treatment of simple and complex brain aneurysms.

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“…3 The requirement for antiplatelet agents also limits their application in patients with a history of rupture. 20 Another major concern is the high recanalization and retreatment rates, 5,6 as well as the high risk of incomplete occlusion, 11,40 which may render the endovascular method ineffective. Therefore, we should also remind ourselves that the clinical course after FDD placement is not inevitably benign or without risk, and the morbidity and mortality rates associated with these endovascular series consistently exceeded those reported by experienced microneurosurgeons.…”

Section: Endovascular Treatment Of Cmcaasmentioning

confidence: 99%

Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms

Wang

Cai

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe rapid innovation of the endovascular armamentarium results in a decreased number of indications for a classic surgical approach. However, a middle cerebral artery (MCA) aneurysm remains the best example of one for which results have favored microsurgery over endovascular intervention. In this study, the authors aimed to evaluate the experience and efficacy regarding surgical outcomes after applying internal maxillary artery (IMA) bypass for complex MCA aneurysms (CMCAAs).METHODSAll IMA bypasses performed between January 2010 and July 2018 in a single-center, single-surgeon practice were screened.RESULTSIn total, 12 patients (9 males, 3 females) with CMCAAs managed by high-flow IMA bypass were identified. The mean size of CMCAAs was 23.7 mm (range 10–37 mm), and the patients had a mean age of 31.7 years (range 14–56 years). The aneurysms were proximally occluded in 8 cases, completely trapped in 3 cases, and completely resected in 1 case. The radial artery was used as the graft vessel in all cases. At discharge, the graft patency rate was 83.3% (n = 10), and all aneurysms were completely eliminated (83.3%, n = 10) or greatly diminished (16.7%, n = 2) from the circulation. Postoperative ischemia was detected in 2 patients as a result of graft occlusion, and 1 patient presenting with subarachnoid hemorrhage achieved improved modified Rankin Scale scores compared to the preoperative status but retained some neurological deficits. Therefore, neurological assessment at discharge showed that 9 of the 12 patients experienced unremarkable outcomes. The mean interval time from bypass to angiographic and clinical follow-up was 28.7 months (range 2–74 months) and 53.1 months (range 19–82 months), respectively. Although 2 grafts remained occluded, all aneurysms were isolated from the circulation, and no patient had an unfavorable outcome.CONCLUSIONSThe satisfactory result in the present study demonstrated that IMA bypass is a promising method for the treatment of CMCAAs and should be maintained in the neurosurgical armamentarium. However, cases with intraoperative radical resection or inappropriate bypass recipient selection such as aneurysmal wall should be meticulously chosen with respect to the subtype of MCA aneurysm.

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Surgical Treatment of Middle Cerebral Artery Aneurysms: Aneurysm Location and Size Ratio as Risk Factors for Neurologic Worsening and Ischemic Complications

Cited by 11 publications

References 21 publications

Endovascular coil embolization of proximal middle cerebral artery aneurysms has better outcomes than other middle cerebral artery aneurysms: A retrospective study

Endovascular coil embolization of proximal middle cerebral artery aneurysms has better outcomes than other middle cerebral artery aneurysms: A retrospective study

Three-Dimensional Virtual Reality Simulation to Safe Planning Neurosurgical Procedure in Brain Aneurysms, Latin American Single-Center Experience: Advantages and Limitations

Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms

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