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

Kivipelto, Leena; Niemelä, Mika; Meling, Torstein R.; Lehečka, Martin; Lehto, Hanna; Hernesniemi, Juha

doi:10.3171/2013.10.jns13738

Cited by 68 publications

(44 citation statements)

References 49 publications

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“…There were no significant differences in the answers between groups for the question of how successful the participant was in accomplishing the task (p = 0.38), which contradicts the results obtained by the objective measurements (see construct validity). With regard to questions about the ability of the model to improve microsurgical techniques and instrument handling, 30 of 30 (100%) participants answered positively (within the interval of [15][16][17][18][19][20]. In addition, 30 of 30 participants considered the model to be able to improve surgical technique when the skills were applied to patients (scores within the interval of [15][16][17][18][19][20].…”

Section: Face and Content Validitymentioning

confidence: 99%

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confidence: 99%

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Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study

Belykh

Lei

Safavi–Abbasi

et al. 2016

JNS

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N eurosurgical vascular cases often require complex microvascular bypass techniques, such as those used in operative corrections for moyamoya disease, 7,26,32 cerebral aneurysms, 9,13,14,19 and intracranial tumors. 30,31 Therefore, simple and accessible models for microvascular anastomosis training are increasingly essential for providing a means for refining and preserving skills. Several models, including chicken wings, 12,17 turkey wings, 1 rats, 15 human cadavers, 24,29 and plastic tubing, 22 have been proposed. However, these models are still less than ideal for various reasons, such as vessel diameter diversity, cost-effectiveness, artifacts due to storage (e.g., Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study obJective Microvascular anastomosis is a basic neurosurgical technique that should be mastered in the laboratory. Human and bovine placentas have been proposed as convenient surgical practice models; however, the histologic characteristics of these tissues have not been compared with human cerebral vessels, and the models have not been validated as simulation training models. In this study, the authors assessed the construct, face, and content validities of microvascular bypass simulation models that used human and bovine placental vessels. methods The characteristics of vessel segments from 30 human and 10 bovine placentas were assessed anatomically and histologically. Microvascular bypasses were performed on the placenta models according to a delineated training module by "trained" participants (10 practicing neurosurgeons and 7 residents with microsurgical experience) and "untrained" participants (10 medical students and 3 residents without experience). Anastomosis performance and impressions of the model were assessed using the Northwestern Objective Microanastomosis Assessment Tool (NOMAT) scale and a posttraining survey. results Human placental arteries were found to approximate the M 2 -M 4 cerebral and superficial temporal arteries, and bovine placental veins were found to approximate the internal carotid and radial arteries. The mean NOMAT performance score was 37.2 ± 7.0 in the untrained group versus 62.7 ± 6.1 in the trained group (p < 0.01; construct validity). A 50% probability of allocation to either group corresponded to 50 NOMAT points. In the posttraining survey, 16 of 17 of the trained participants (94%) scored the model's replication of real bypass surgery as high, and 16 of 17 (94%) scored the difficulty as "the same" (face validity). All participants, 30 of 30 (100%), answered positively to questions regarding the ability of the model to improve microsurgical technique (content validity). coNclusioNs Human placental arteries and bovine placental veins are convenient, anatomically relevant, and beneficial models for microneurosurgical training. Microanastomosis simulation using these models has high face, content, and construct validities. A NOMAT score of more than 5...

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Section: Face and Content Validitymentioning

confidence: 99%

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mentioning

confidence: 99%

Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study

Belykh

Lei

Safavi–Abbasi

et al. 2016

JNS

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“…(4,5,8) In cases where the branches cannot be dissected from the fragile aneurysm wall, using fenestrated clips alone or stacked together to create tubes around the branch should be considered. (13) Unfortunately we had no such clips available for this surgery.…”

Section: Discussionmentioning

confidence: 99%

Clip reconstruction of a large right MCA bifurcation aneurysm. Case report

Giovani¹,

Neacsu²,

Gheorghiu³

et al. 2014

Romanian Neurosurgery

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We report a case of complex large middle cerebral artery (MCA) bifurcation aneurysm that ruptured during dissection from the very adherent MCA branches but was successfully clipped and the MCA bifurcation reconstructed using 4 Yasargill clips. Through a right pterional craniotomy the sylvian fissure was largely opened as to allow enough workspace for clipping the aneurysm and placing a temporary clip on M1. The pacient recovered very well after surgery and was discharged after 1 week with no neurological deficit. Complex MCA bifurcation aneurysms can be safely reconstructed using regular clips, without the need of using fenestrated clips or complex by-pass procedures.

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“…Complete trapping can be hazardous, for instance, when perforating vessels arise from the aneurysmal sac or when careful visual inspection of every aspect of the aneurysm is not feasible. In these patients, partial trapping strategies may be the best alternative [9,13,14,18,20,25,29,31].…”

Section: Introductionmentioning

confidence: 99%

Distal outflow occlusion with bypass revascularization: last resort measure in managing complex MCA and PICA aneurysms

2016

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

Cited by 68 publications

References 49 publications

Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study

Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study

Clip reconstruction of a large right MCA bifurcation aneurysm. Case report

Distal outflow occlusion with bypass revascularization: last resort measure in managing complex MCA and PICA aneurysms

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