Treatment of Ruptured Spontaneous Saccular Aneurysm in the Central Artery of the Middle Cerebral Artery Using Bypass Surgery Combined With Trapping  -Case Report-

Saitō, Hideo; Ogasawara, Kuniaki; Kubo, Yoshitaka; Saso, Masayuki; Otawara, Yasunari

doi:10.2176/nmc.47.471

Cited by 7 publications

(7 citation statements)

References 19 publications

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“…32 A wide variety of bypass techniques for MCA aneurysms exist because they are so amenable to both traditional extracranial-to-intracranial (EC-IC) bypasses, such as superficial temporal artery (STA) bypass and high-flow interpositional bypass to the cervical carotid artery, and reconstructive IC-IC bypasses, such as the end-to-end reanastomosis and the double-reimplantation technique. 4,6,8,[11][12][13][14][17][18][19]22,25,28,[30][31][32][33][34]37,39,43,50,51 The pathological spectrum of MCA aneurysms combined with the variety of applicable bypasses makes it challenging to select the optimal bypass, particularly when these decisions must be made intraoperatively in response to unexpected anatomy or technical complications. To our knowledge, no algorithm to guide these decisions or surgical plans exists.…”

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confidence: 99%

Bypass surgery for complex middle cerebral artery aneurysms: an algorithmic approach to revascularization

Meybodi

Huang²,

Benet

et al. 2017

Journal of Neurosurgery

112

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OBJECT Management of complex aneurysms of the middle cerebral artery (MCA) can be challenging. Lesions not amenable to endovascular techniques or direct clipping might require a bypass procedure with aneurysm obliteration. Various bypass techniques are available, but an algorithmic approach to classifying these lesions and determining the optimal bypass strategy has not been developed. The objective of this study was to propose a comprehensive and flexible algorithm based on MCA aneurysm location for selecting the best of multiple bypass options. METHODS Aneurysms of the MCA that required bypass as part of treatment were identified from a large prospectively maintained database of vascular neurosurgeries. According to its location relative to the bifurcation, each aneurysm was classified as a prebifurcation, bifurcation, or postbifurcation aneurysm. RESULTS Between 1998 and 2015, 30 patients were treated for 30 complex MCA aneurysms in 8 (27%) prebifurcation, 5 (17%) bifurcation, and 17 (56%) postbifurcation locations. Bypasses included 8 superficial temporal artery-MCA bypasses, 4 high-flow extracranial-to-intracranial (EC-IC) bypasses, 13 IC-IC bypasses (6 reanastomoses, 3 reimplantations, 3 interpositional grafts, and 1 in situ bypass), and 5 combination bypasses. The bypass strategy for prebifurcation aneurysms was determined by the involvement of lenticulostriate arteries, whereas the bypass strategy for bifurcation aneurysms was determined by rupture status. The location of the MCA aneurysm in the candelabra (Sylvian, insular, or opercular) determined the bypass strategy for postbifurcation aneurysms. No deaths that resulted from surgery were found, bypass patency was 90%, and the condition of 90% of the patients was improved or unchanged at the most recent follow-up. CONCLUSIONS The bypass strategy used for an MCA aneurysm depends on the aneurysm location, lenticulostriate anatomy, and rupture status. A uniform bypass strategy for all MCA aneurysms does not exist, but the algorithm proposed here might guide selection of the optimal EC-IC or IC-IC bypass technique.

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confidence: 99%

Bypass surgery for complex middle cerebral artery aneurysms: an algorithmic approach to revascularization

Meybodi

Huang²,

Benet

et al. 2017

Journal of Neurosurgery

112

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“…A similar philosophy and technique to ours is presented by Japanese authors, who consider trapping the aneurysm along with an STA-MCA bypass to be the primary option in cases such as ours. Saito et al [13] present the case of an unclippable non-dissecting ruptured saccular aneurysm of the central MCA branch and Sakamoto et al [14] describe the case of a dissecting aneurysm of the M3 MCA segment, both of which were treated using a technique similar to ours. Nakahara et al [15] depict the complexity in treating distal mycotic aneurysms in five cases.…”

Section: Discussionmentioning

confidence: 91%

Bypass Procedure Performed in the Field of a Decompressive Craniectomy in the Case of an MCA Dissecting Aneurysm: Case Report and Review of the Literature

et al. 2020

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Treatment of complex aneurysms often requires additional surgical tools including the use of the extra-intracranial (EC-IC) bypass. The following report depicts the utilization of the EC-IC bypass in treating a dissecting aneurysm several hours after a salvage emergent evacuation of an acute subdural hematoma via decompressive craniectomy (DC). Preserving the superficial temporal artery during the DC provided a donor artery for the bypass surgery.

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“…Headache and altered mental status were the most common presentations, followed by ICH and subdural hematoma. [ 13 , 17 , 18 , 20 , 22 ] Concomitant subarachnoid hemorrhage (SAH) was reported in two cases only. Information on aneurysm morphology was available in eight of the 15 cases; seven of the aneurysms were saccular, and one was fusiform.…”

Section: Discussionmentioning

confidence: 99%

Ruptured giant aneurysm of a cortical middle cerebral artery: A case report

Hoz

Aljuboori

Albanaa

et al. 2021

Surgical Neurology International

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Background: Aneurysms of the cortical branches of the middle cerebral artery (MCA) are rare. They usually are secondary to traumatic or infectious etiologies and are rarely idiopathic. The specific characteristics of idiopathic aneurysms in such location are not well defined in the literature. The authors report a rare case of a ruptured giant idiopathic cortical MCA aneurysm with review of the available literature on this clinical entity. Case Description: A 24-year-old female presented with headache, disturbed level of consciousness, and right-sided weakness. Imaging studies showed a left frontoparietal intracerebral hematoma and a giant saccular aneurysm in the posterior parietal cortical branch of the MCA. The patient had no history of head trauma or active infection; therefore, the aneurysm was considered idiopathic. A microsurgical clipping of the aneurysm with evacuation of the hematoma was performed. There were no surgical complications, and the patient achieved a good outcome modified Rankin Scale of 1 with no neurological deficits. Conclusion: Idiopathic aneurysms of the cortical branches of the MCA are rare, and usually present with intraparenchymal hemorrhage due to rupture. There is no clear consensus regarding the optimal management strategy. This case shows that timely management can lead to good outcomes.

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Treatment of Ruptured Spontaneous Saccular Aneurysm in the Central Artery of the Middle Cerebral Artery Using Bypass Surgery Combined With Trapping -Case Report-

Cited by 7 publications

References 19 publications

Bypass surgery for complex middle cerebral artery aneurysms: an algorithmic approach to revascularization

Bypass surgery for complex middle cerebral artery aneurysms: an algorithmic approach to revascularization

Bypass Procedure Performed in the Field of a Decompressive Craniectomy in the Case of an MCA Dissecting Aneurysm: Case Report and Review of the Literature

Ruptured giant aneurysm of a cortical middle cerebral artery: A case report

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