Clinical and radiological outcomes in relation with the anatomical orientation of clipped middle cerebral artery bifurcation aneurysms.
Adult
Aged
Aged, 80 and over
Aneurysm, Ruptured
/ diagnostic imaging
Angiography, Digital Subtraction
Brain Ischemia
/ diagnostic imaging
Cerebral Angiography
Computed Tomography Angiography
Female
Humans
Intracranial Aneurysm
/ diagnostic imaging
Intracranial Hemorrhages
/ diagnostic imaging
Magnetic Resonance Imaging
Male
Microsurgery
Middle Aged
Middle Cerebral Artery
/ diagnostic imaging
Neurosurgical Procedures
Postoperative Complications
/ diagnostic imaging
Surgical Instruments
Ultrasonography, Doppler, Transcranial
Vasospasm, Intracranial
/ diagnostic imaging
Aneurysms
Bifurcation
Clipping
MCA
Orientation
Journal
Clinical neurology and neurosurgery
ISSN: 1872-6968
Titre abrégé: Clin Neurol Neurosurg
Pays: Netherlands
ID NLM: 7502039
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
16
11
2020
revised:
09
01
2021
accepted:
11
01
2021
pubmed:
25
1
2021
medline:
18
1
2022
entrez:
24
1
2021
Statut:
ppublish
Résumé
The middle cerebral artery (MCA) bifurcation represents the most frequent location for intracranial aneurysms. Often, the aneurysmal dome can hide the origin of perforating arteries from the M1 segment during the surgical clipping causing ischemic lesions and worse clinical outcome. The aim of this paper is to analyze the association between the orientation of the aneurysm sac and the clinical and radiological outcomes after surgical clipping. Data from 50 MCA bifurcation clipped aneurysms in 47 patients were collected retrospectively. Three different groups were identified according to the aneurysmal sac orientation: anterior-inferior, posterior and superior. A possible association between the aneurysmal sac projection and the outcome was searched through a univariable logistic regression analysis. Statistical analysis showed significant correlation between the radiologic evidence of post-operative ischemia in the posterior group (p = 0.046, RR = 1.65) and an increased risk in the superior orientation group (p = 0.145, RR = 1.38). The anterior-inferior group was, instead, significantly associated with no evidence of radiologic ischemia (p = 0.0019, RR = 0.58). The orientation of the aneurysmal dome and sac represents a fundamental feature to be considered during the surgical clipping of the MCA aneurysms. Indeed, its posterior and superior projection is associated with a higher incidence of radiologic ischemic lesions due to the origin of perforating arteries from M1 segment behind the aneurysmal sac. The anterior-inferior orientation, on the contrary, is associated with a lower risk.
Sections du résumé
BACKGROUND
BACKGROUND
The middle cerebral artery (MCA) bifurcation represents the most frequent location for intracranial aneurysms. Often, the aneurysmal dome can hide the origin of perforating arteries from the M1 segment during the surgical clipping causing ischemic lesions and worse clinical outcome. The aim of this paper is to analyze the association between the orientation of the aneurysm sac and the clinical and radiological outcomes after surgical clipping.
METHODS
METHODS
Data from 50 MCA bifurcation clipped aneurysms in 47 patients were collected retrospectively. Three different groups were identified according to the aneurysmal sac orientation: anterior-inferior, posterior and superior. A possible association between the aneurysmal sac projection and the outcome was searched through a univariable logistic regression analysis.
RESULTS
RESULTS
Statistical analysis showed significant correlation between the radiologic evidence of post-operative ischemia in the posterior group (p = 0.046, RR = 1.65) and an increased risk in the superior orientation group (p = 0.145, RR = 1.38). The anterior-inferior group was, instead, significantly associated with no evidence of radiologic ischemia (p = 0.0019, RR = 0.58).
CONCLUSION
CONCLUSIONS
The orientation of the aneurysmal dome and sac represents a fundamental feature to be considered during the surgical clipping of the MCA aneurysms. Indeed, its posterior and superior projection is associated with a higher incidence of radiologic ischemic lesions due to the origin of perforating arteries from M1 segment behind the aneurysmal sac. The anterior-inferior orientation, on the contrary, is associated with a lower risk.
Identifiants
pubmed: 33486156
pii: S0303-8467(21)00018-4
doi: 10.1016/j.clineuro.2021.106491
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
106491Informations de copyright
Copyright © 2021 Elsevier B.V. All rights reserved.