Giant Middle Cerebral Artery Aneurysms: A 55-Patient Series.
Adolescent
Adult
Aged
Cerebral Revascularization
/ adverse effects
Child
Child, Preschool
Endovascular Procedures
/ adverse effects
Female
Follow-Up Studies
Humans
Intracranial Aneurysm
/ diagnostic imaging
Male
Middle Aged
Postoperative Complications
/ diagnostic imaging
Retrospective Studies
Young Adult
Bypass
Clipping
Complex aneurysms
Giant aneurysm
MCA aneurysms
Middle cerebral artery aneurysms
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
07
07
2021
revised:
26
08
2021
accepted:
27
08
2021
pubmed:
8
9
2021
medline:
13
1
2022
entrez:
7
9
2021
Statut:
ppublish
Résumé
The treatment of middle cerebral artery (MCA) giant aneurysms (GAs) represents a challenging task. The data for 55 patients treated for MCA GA (≥25 mm) at the N.N. Burdenko NMRCN between 2010 and 2019 were analyZed. The GAs were located in the M1 segment in 11 (20%) patients, MCA bifurcation in 33 (60%), M2 in 7 (12.7%), and M3 in 4 (7.3%). There were 32 (58.2%) saccular and 23 (41.8%) fusiform GAs. MCA GAs were treated with neck clipping (50.9%), clipping with the artery lumen formation (3.6%), bypass surgeries (34.5%), wrapping (3.6%), and endovascular surgery (7.3%). A worsening of the neurologic state in the perioperative period was observed in 50.9% of patients. The complete closure of GA was achieved in 78.2%. Surgery-related mortality was 1.8%. The long-term outcome was favorable in 76.9% of patients. Surgery-related and disease-related plus treatment failures-related mortality was 9.6%. Microsurgical clipping and bypass surgery are the main operative interventions for MCA GA treatment. These operations are technically complex and are followed by a relatively high percentage of complications. The main tasks that require further investigations are the introduction of new precise diagnostic methods for the collateral circulation assessment in the cortical MCA branches, the perfection of the algorithm for the bypass selection, and investigation of the long-term results of the endovascular and combined treatments. It is of major importance to thoroughly observe the patients long-term after the surgery and ensure the possibility for further angiographic studies.
Sections du résumé
BACKGROUND
The treatment of middle cerebral artery (MCA) giant aneurysms (GAs) represents a challenging task.
METHODS
The data for 55 patients treated for MCA GA (≥25 mm) at the N.N. Burdenko NMRCN between 2010 and 2019 were analyZed.
RESULTS
The GAs were located in the M1 segment in 11 (20%) patients, MCA bifurcation in 33 (60%), M2 in 7 (12.7%), and M3 in 4 (7.3%). There were 32 (58.2%) saccular and 23 (41.8%) fusiform GAs. MCA GAs were treated with neck clipping (50.9%), clipping with the artery lumen formation (3.6%), bypass surgeries (34.5%), wrapping (3.6%), and endovascular surgery (7.3%). A worsening of the neurologic state in the perioperative period was observed in 50.9% of patients. The complete closure of GA was achieved in 78.2%. Surgery-related mortality was 1.8%. The long-term outcome was favorable in 76.9% of patients. Surgery-related and disease-related plus treatment failures-related mortality was 9.6%.
CONCLUSIONS
Microsurgical clipping and bypass surgery are the main operative interventions for MCA GA treatment. These operations are technically complex and are followed by a relatively high percentage of complications. The main tasks that require further investigations are the introduction of new precise diagnostic methods for the collateral circulation assessment in the cortical MCA branches, the perfection of the algorithm for the bypass selection, and investigation of the long-term results of the endovascular and combined treatments. It is of major importance to thoroughly observe the patients long-term after the surgery and ensure the possibility for further angiographic studies.
Identifiants
pubmed: 34492390
pii: S1878-8750(21)01316-4
doi: 10.1016/j.wneu.2021.08.128
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e727-e737Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.