Results of surgical treatment of patients with aneurysms of the middle cerebral artery
Keywords:
craniotomy, intracranial aneurysm, subarachnoid hemorrhage, microsurgery.Abstract
Introduction: Aneurysms of the middle cerebral artery are usually responsible for intracranial bleeding and constitute a frequent location of aneurysms. Its close arterial and venous relationship in the Silvian cistern is accompanied by high complexity. Surgical clipping is highly effective.Objective: To describe the surgical results of middle cerebral artery aneurysms operated using microsurgical clipping.
Method: A descriptive, prospective study was carried out that included 50 patients from the Hermanos Ameijeiras Hospital operated on for cerebral aneurysm of the middle cerebral artery using microsurgical clipping. A pterional and minipterional craniotomy and clipping of the aneurysm were performed. The variables studied were: clinical, cerebral aneurysm and postoperative with greater importance related to complications and the Glasgow Coma Scale for results. For data analysis, absolute and relative frequencies were used as summary measures.
Results: There was a predominance of unruptured aneurysms (66.0%) of large size (42.0%) and located in the bifurcation of the middle cerebral artery (94.0%). Minipterional craniotomy was used in 74.0%. In relation to the main complications, vasospasm (8.0%), hydrocephalus (6.0%) and cerebral infarction (4.0%) were reported. According to the Glasgow Coma Scale for results, there was a greater presence of grade 5 (78.0%).
Conclusions: Microsurgical clipping in patients with middle cerebral artery aneurysms is accompanied by total clipping and few postoperative complications.
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References
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23. Takeda N, Kurihara E, Kuroda R, Inoue S, Lee TJ, Sasayama T. Ruptured Distal Middle Cerebral Artery Aneurysms-Characteristics and Strategy. World Neurosurg. 2022; 167:e370-e377. DOI: 10.1016/j.wneu.2022.08.017
24. Zijlstra IA, van der Steen WE, Verbaan D, Majoie CB, Marquering HA, Coert BA, et al. Ruptured middle cerebral artery aneurysms with a concomitant intraparenchymal hematoma: the role of hematoma volume. Neuroradiology. 2018; 60(3):335-42. DOI: 10.1007/s00234-018-1978-4
25. Marchi F, Bonasia S, Chiappini A, Reinert M, Robert T. Clinical and radiological outcomes in relation with the anatomical orientation of clipped middle cerebral artery bifurcation aneurysms. Clin Neurol Neurosurg. 2021; 202:106491. DOI: 10.1016/j.clineuro.2021.106491
26. Sriamornrattanakul K, Akharathammachote N, Wongsuriyanan S. Early Exposure of the Dorsal Surface of M1 Segment via the Distal Transsylvian Approach for Clipping of Anteroinferior-Projecting Middle Cerebral Artery Bifurcation Aneurysms. Asian J Neurosurg. 2022; 17(1):23-30. DOI: 10.1055/s-0042-1749177
27. Mori K. Keyhole concept in cerebral aneurysm clipping and tumor removal by the supraciliary lateral supraorbital approach. Asian J Neurosurg. 2014; 9(1):14-20. DOI: 10.4103/1793-5482.131059
28. Metayer T, Leclerc A, Borha A, Derrey S, Langlois O, Barbier C, et al. Microsurgical Clipping of Middle Cerebral Artery Aneurysms: Complications and Risk Factors for Complications. World Neurosurg. 2022; 168:e87-e96. DOI: 10.1016/j.wneu.2022.09.044
29. Mooney MA, Simon ED, Brigeman S, Nakaji P, Zabramski JM, Lawton MT, et al. Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial. J Neurosurg. 2018; 130(3):895-901. DOI: 10.3171/2017.10.JNS172183
2. Dashti R, Hernesniemi J, Niemelä M, Rinne J, Porras M, Lehecka M, et al. Microneurosurgical management of middle cerebral artery bifurcation aneurysms. Surg Neurol. 2007; 67(5):441-56. DOI: 10.1016/j.surneu.2006.11.056
3. Inagawa T. Prevalence of cerebral aneurysms in autopsy studies: a review of the literature. Neurosurg Rev. 2022; 45(4):2565-82. DOI: 10.1007/s10143-022-01783-7
4. Pásztor E, Vajda J, Juhász J, Tóth S, Orosz E, Horváth M. The surgery of middle cerebral artery aneurysms. Acta Neurochir (Wien). 1986;82(3-4):92-101. DOI: 10.1007/BF01456367
5. Ding D. Surgical treatment of unruptured middle cerebral artery aneurysms: Complication avoidance. Clin Neurol Neurosurg. 2017; 153:107-8. DOI: 10.1016/j.clineuro.2016.11.002
6. Tawk RG, Hasan TF, D'Souza CE, Peel JB, Freeman WD. Diagnosis and Treatment of Unruptured Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage. Mayo Clin Proc. 2021; 96(7):1970-2000. DOI: 10.1016/j.mayocp.2021.01.005
7. Le K, Heskett C, De Stefano FA, Fry L, Lei C, Dharia, et al. An Analysis of Landmark Articles Regarding Aneurysms of the Middle Cerebral Artery. World Neurosurg. 2023; 171:72-83. DOI: 10.1016/j.wneu.2022.11.135
8. Hishikawa T, Date I, Tokunaga K, Tominari S, Nozaki K, Shiokawa Y, et al. For UCAS Japan and UCAS II Investigators. Risk of rupture of unruptured cerebral aneurysms in elderly patients. Neurology. 2015; 85(21):1879-85. DOI: 10.1212/WNL.0000000000002149
9. Darsaut TE, Keough MB, Sagga A, Chan VKY, Diouf A, Boisseau W, et al. Surgical or Endovascular Management of Middle Cerebral Artery Aneurysms: A Randomized Comparison. World Neurosurg. 2021; 149:e521-e534. DOI: 10.1016/j.wneu.2021.01.142
10. Boisseau W, Darsaut TE, Fahed R, Findlay JM, Bourcier R, Charbonnier G, et al. Surgical or Endovascular Treatment of MCA Aneurysms: An Agreement Study. AJNR Am J Neuroradiol. 2022; 43(10):1437-1444. DOI: 10.3174/ajnr.A7648
11. Sturiale CL, Rapisarda A, Marchese E, Puca A, Olivi A, Albanese A. Surgical Treatment of Middle Cerebral Artery Aneurysms: Hints and Precautions for Young Cerebrovascular Surgeons. J Neurol Surg A Cent Eur Neurosurg. 2022; 83(1):75-84. DOI: 10.1055/s-0040-1720996
12. Rodríguez-Hernández A, Sughrue ME, Akhavan S, Habdank-Kolaczkowski J, Lawton MT. Current management of middle cerebral artery aneurysms: surgical results with a "clip first" policy. Neurosurgery. 2013; 72(3):415-27. DOI: 10.1227/NEU.0b013e3182804aa2
13. Rodríguez-Hernández A, Lawton MT. Flash fluorescence with indocyanine green videoangiography to identify the recipient artery for bypass with distal middle cerebral artery aneurysms: operative technique. Neurosurgery. 2012; 70(2 Suppl Operative):209-20. DOI: 10.1227/NEU.0b013e31823158f3
14. Sano H, Satoh A, Murayama Y, Kato Y, Origasa H, Inamasu J, et al. Members of the 38 registered institutions and WFNS Cerebrovascular Disease & Treatment Committee. Modified World Federation of Neurosurgical Societies subarachnoid hemorrhage grading system. World Neurosurg. 2015; 83(5):801-7. DOI: 10.1016/j.wneu.2014.12.032
15. Frontera JA, Claassen J, Schmidt JM, Wartenberg KE, Temes R, Connolly ES Jr, et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery. 2006; 59(1):21-7. DOI: 10.1227/01.neu.0000243277.86222.6cV
16. Jennett B, Snoek J, Bond MR, Brooks N. Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry. 1981; 44(4):285-93. DOI: 10.1136/jnnp.44.4.285
17. Yasargil MG. Interfascial pterional (frontotemporosphenoidal) craniotomy, in Yasargil MG (ed): Microneurosurgery. Vol. 1. Stuttgart: Georg Thieme Verlag; 1984.
18. Figueiredo EG, Welling LC, Preul MC, Sakaya GR, Neville I, Spetzler RF, et al. Surgical experience of minipterional craniotomy with 102 ruptured and unruptured anterior circulation aneurysms. J Clin Neurosci. 2016; 27:34-9. DOI: 10.1016/j.jocn.2015.07.032
19. Karadag A, Bozkurt B, Yagmurlu K, Ozcan AI, Moen S, Grande AW. Microsurgical Management of the Middle Cerebral Artery Bifurcation Aneurysms: An Anatomic Feasibility Study. ORL J Otorhinolaryngol Relat Spec. 2021; 83(3):187-195. DOI: 10.1159/000514177
20. Tian Z, Mu S, Li W, Zhu W, Zhang Y, Yang X, et al. Recurrence of an internal carotid artery aneurysm after complete exclusion by a Willis covered stent. Interv Neuroradiol. 2019; 25(6):688-91. DOI: 10.1177/1591019919854184
21. Yang K, Begley SL, Lynch D, Turpin J, Aminnejad M, Farrokhyar F, et al. Long-term outcomes of surgical clipping of saccular middle cerebral artery aneurysms: a consecutive series of 92 patients. Neurosurg Rev. 2023; 46(1):271. DOI: 10.1007/s10143-023-02167-1
22. Jeong YG, Jung YT, Kim MS, Eun CK, Jang SH. Size and location of ruptured intracranial aneurysms. J Korean Neurosurg Soc. 2009; 45(1):11-5. DOI: 10.3340/jkns.2009.45.1.11
23. Takeda N, Kurihara E, Kuroda R, Inoue S, Lee TJ, Sasayama T. Ruptured Distal Middle Cerebral Artery Aneurysms-Characteristics and Strategy. World Neurosurg. 2022; 167:e370-e377. DOI: 10.1016/j.wneu.2022.08.017
24. Zijlstra IA, van der Steen WE, Verbaan D, Majoie CB, Marquering HA, Coert BA, et al. Ruptured middle cerebral artery aneurysms with a concomitant intraparenchymal hematoma: the role of hematoma volume. Neuroradiology. 2018; 60(3):335-42. DOI: 10.1007/s00234-018-1978-4
25. Marchi F, Bonasia S, Chiappini A, Reinert M, Robert T. Clinical and radiological outcomes in relation with the anatomical orientation of clipped middle cerebral artery bifurcation aneurysms. Clin Neurol Neurosurg. 2021; 202:106491. DOI: 10.1016/j.clineuro.2021.106491
26. Sriamornrattanakul K, Akharathammachote N, Wongsuriyanan S. Early Exposure of the Dorsal Surface of M1 Segment via the Distal Transsylvian Approach for Clipping of Anteroinferior-Projecting Middle Cerebral Artery Bifurcation Aneurysms. Asian J Neurosurg. 2022; 17(1):23-30. DOI: 10.1055/s-0042-1749177
27. Mori K. Keyhole concept in cerebral aneurysm clipping and tumor removal by the supraciliary lateral supraorbital approach. Asian J Neurosurg. 2014; 9(1):14-20. DOI: 10.4103/1793-5482.131059
28. Metayer T, Leclerc A, Borha A, Derrey S, Langlois O, Barbier C, et al. Microsurgical Clipping of Middle Cerebral Artery Aneurysms: Complications and Risk Factors for Complications. World Neurosurg. 2022; 168:e87-e96. DOI: 10.1016/j.wneu.2022.09.044
29. Mooney MA, Simon ED, Brigeman S, Nakaji P, Zabramski JM, Lawton MT, et al. Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial. J Neurosurg. 2018; 130(3):895-901. DOI: 10.3171/2017.10.JNS172183
Published
2024-06-07
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Mapolon Roman E, Elizondo Barriel LM, Vargas Galvez CR, Lopez Arbolay O, Ortiz Machin MM, Cruz Perez PO. Results of surgical treatment of patients with aneurysms of the middle cerebral artery. Rev Cubana Med Milit [Internet]. 2024 Jun. 7 [cited 2025 Jan. 10];53(2):e024034141. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/34141
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