Surgical aspects for clipping arterial aneurysms of the middle cerebral artery
Abstract
Objective – to improve the methods of surgical treatment arterial aneurysms (AA) of the middle cerebral artery (MCA).
Materials and methods. This work is performed on the material of 112 patients with MCA aneurysms. Patients were treated at Academician A.P. Romodanov Neurosurgery Institute in the period from 2012 to 2015. The age of patients – from 32 to 72 years, the mean age of patients was (49.3 ± 2.5) years. Most of the patients (66.7 %) were in the age group 41-60 years. Concerning the results, they were evaluated according to the radical exclusion of AA MCA from the blood flow at different periods of hemorrhage.
Results. In 95.7 % patients operated during the acute period of hemorrhage, a total exclusion of aneurysms has been achieved. The differences for total clipping of AA MCA in different periods of rupture and in its absence were statistically insignificant (p > 0.05).
Conclusions. Criteria for choosing to perform microsurgical treatment MCA AA are morphometric criteria for wide neck aneurysms, the ratio of the neck to the body 1:3, the size of AA less than 3 mm, the presence of intracerebral hematoma with the existing mass effect, the incorporation one of the branches of the MCA into the wall of the dome AA. It is also necessary to take into the general criteria of neurosurgical data, depending on the general condition of the patient, the clinical course of the disease, topographic and anatomical X-rays features of the structure of AA, taking into account these neuroimaging methods (CT, CTA, DSA).
Downloads
References
Zlotnik Je, Antonov I, Kastrickaja Z, Oleshkevich F. Angiograficheskaja diagnostika sosudistyh porazhenij i opuholej golovnogo mozga (Rus). Minsk: Belarus, 1973: 17-23.
Gusev EI, Konovalov AN, Burd GS. Nevrologija (Rus). M.: Medicina, 2000: 259-90.
Lebedev VV, Krylov VV, Shelkovskij VN. Klinika, diagnostika i lechenie vnutricherepnyh arterialnyh anevrizm vostrom periode krovoizlijanija (Rus). M.: Medicina, 1996: 43-51.
Leipzig TJ, Morgan J, Horner TJ, Payner T, Redelman K, Johnson CS. Analysis of Intraoperative Rupture in the Surgical Treatment of 1694 Succular Aneurysms. Neu- rosurg. 2005;56,3:455-68.
Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366(9488):809-17.
Masson RL Jr, Day Al. Aneurismal intracerebral hemorrhage. Neurosurg. Clin. N. Am. 1992; 3(3): 539-50.
Yasargil MG, Smith RD, Young PH, Teddy PJ, Roth P. Microneursurgery, vol. 2. Stuttgart: Georg Thieme Verlag, 1984:385.
Reynolds A, Shaw CM. Bleeding patterns from ruptured intracranial aneurysms: an autopsy series of 205 patients. Surg. Neurol. 1981;15:232-5.
Molyneux AJ, Kerr RS, Birks J, Ramzi N, Yarnold J, Sneade M, Rischmiller J, ISAT Collaborators. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardized mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol 2009;8(5):427- 33.
Spetzler RF, McDougall CG, Zabramski JM, et al. The Barrow Ruptured Aneurysm Trial: 6-year results. J. Neurosurg. 2015;123(3):609-17. doi: 10.3171/20 14.9.JNS141749.
Nelson PK, Lylyk P, Szikora I, Wetzel SG, Wanke I, Fiorella D. The pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR Am J. Neuroradiol. 2011;32(1):34-40. doi: 10.3174/ajnr. A2421.
Wiebers DO, Whisnant JP, Huston J 3rd et al., International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103- 10.
Yasargil MG. Clinical Considerations, Surgery of the Intracranial Aneurysms and Results. Stuttgart; New York: Georg Thieme Verlag, Thieme Stratton Inc., 1984: 979-994.
