Dome Resection and End-to-End Reanastomosis for a Middle Cerebral Artery Fusiform Aneurysm of the M1 Segment : 2-Dimensional Operative Video
Copyright © 2023 Elsevier Inc. All rights reserved..
Fusiform aneurysms of the middle cerebral artery (MCA) are both relatively uncommon and challenging to treat given their pathophysiology, morphology, and anatomy (e.g., perforating arteries involvement).1,2 Endovascular treatment of fusiform MCA aneurysms can achieve good outcomes in well-selected cases.3,4 Open microsurgical strategies are effective in a case of fusiform MCA aneurysms with complex anatomy or perforator involvement.2,5,6 We demonstrate the bypass strategy for resection of a fusiform M1 MCA aneurysm (Video 1). A 48-year-old female was referred for the treatment of a growing incidental right M1 MCA fusiform aneurysm. Imaging showed a tortuous M1 segment with no apparent perforator involvement, which we considered a candidate for resection and reanastomosis. A modified minipterional transsylvian approach was performed as described earlier.7,8 A double superficial temporal artery to middle cerebral artery bypass was performed to maintain flow to MCA territory and distal perforators in anticipation of a long temporary flow arrest due to complex aneurysmal dissection and reanastomosis and also to serve as long-term protective insurance. Resection and end-to-end reanastomosis will preserve the antegrade flow and prevent the risk stump thrombosis carried by a simple trapping.9,10 We cover the nuances of this technique including key steps to an efficient aneurysmal resection and complication avoidance. The patient tolerated the procedure well, and postoperative imaging showed no aneurysmal remnant and flow restoration with no evidence of stroke. We discharged the patient home with a modified Rankin scale of 0. The patient consented to the procedure and publication of his or her image.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:178 |
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| Enthalten in: |
World neurosurgery - 178(2023) vom: 19. Okt., Seite 114 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kusdiansah, Muhammad [VerfasserIn] |
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| Links: |
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| Themen: |
Aneurysm resection |
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| Anmerkungen: |
Date Completed 09.10.2023 Date Revised 09.10.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.wneu.2023.07.047 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM359742971 |
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| 520 | |a Copyright © 2023 Elsevier Inc. All rights reserved. | ||
| 520 | |a Fusiform aneurysms of the middle cerebral artery (MCA) are both relatively uncommon and challenging to treat given their pathophysiology, morphology, and anatomy (e.g., perforating arteries involvement).1,2 Endovascular treatment of fusiform MCA aneurysms can achieve good outcomes in well-selected cases.3,4 Open microsurgical strategies are effective in a case of fusiform MCA aneurysms with complex anatomy or perforator involvement.2,5,6 We demonstrate the bypass strategy for resection of a fusiform M1 MCA aneurysm (Video 1). A 48-year-old female was referred for the treatment of a growing incidental right M1 MCA fusiform aneurysm. Imaging showed a tortuous M1 segment with no apparent perforator involvement, which we considered a candidate for resection and reanastomosis. A modified minipterional transsylvian approach was performed as described earlier.7,8 A double superficial temporal artery to middle cerebral artery bypass was performed to maintain flow to MCA territory and distal perforators in anticipation of a long temporary flow arrest due to complex aneurysmal dissection and reanastomosis and also to serve as long-term protective insurance. Resection and end-to-end reanastomosis will preserve the antegrade flow and prevent the risk stump thrombosis carried by a simple trapping.9,10 We cover the nuances of this technique including key steps to an efficient aneurysmal resection and complication avoidance. The patient tolerated the procedure well, and postoperative imaging showed no aneurysmal remnant and flow restoration with no evidence of stroke. We discharged the patient home with a modified Rankin scale of 0. The patient consented to the procedure and publication of his or her image | ||
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| 700 | 1 | |a Tanikawa, Rokuya |e verfasserin |4 aut | |
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