Treatment of Giant Middle Cerebral Artery Aneurysms With a Flow Replacement Bypass Using the Excimer Laser-Assisted Nonocclusive Anastomosis Technique

Doormaal, Tristan P.C. van; Zwan, Albert van der; Verweij, Bon H.; Han, Kuo Sen; Langer, David; Tulleken, Cornelis A.F.

doi:10.1227/01.neu.0000335066.45566.d1

Cited by 53 publications

(37 citation statements)

References 35 publications

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“…Moreover, increasing flow in leptomeningeal collaterals can lead to decreasing flow in the bypass, resulting in a delayed bypass occlusion with no or only mild neurological symptoms. 46 This was also observed among our patients: the natural collaterals "take over" and eventually make the bypass unnecessary. Similar collateral variability exists also in the internal capsule and basal ganglion area and probably explains why certain patients suffered permanent deficits after M 1 aneurysm treatment (in this study, unintentional occlusion of lenticulostriate perforators) while only transient deficits were seen in some others, even after complete trapping of M 1 aneurysms.…”

Section: 36supporting

confidence: 76%

“…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%

“…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. The complete aneurysm obliteration rate was not reported clearly.…”

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.…”

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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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: 36supporting

confidence: 76%

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

View full text Add to dashboard Cite

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“…Standard microsurgical techniques in the treatment of these lesions have been associated with high morbidity, though newer advances have improved results (Wehman et al 2006;Kassell et al 1990a, b;van Doormaal et al 2008). Unfortunately, giant IAAs are extremely recalcitrant to selective coil embolization and show very high rates of recurrence, especially if partial thrombosis is present.…”

Section: Giant Aneurysmsmentioning

confidence: 99%