Complex Middle Cerebral Artery Research Articles

Reconstruction Options for Complex Middle Cerebral Artery Aneurysms

To describe techniques of reconstruction for unclippable and uncoilable middle cerebral artery aneurysms. A retrospective review was performed of seven patients who underwent eight operations during a 9-year period to treat complex middle cerebral artery bifurcation aneurysms not amenable to direct clipping or endovascular coiling. All preoperative and postoperative clinical and imaging data were reviewed. Follow-up was obtained for all patients via clinic visit and/or telephone. The operative techniques used included saphenous vein graft bypass (n = 1), radial artery graft interposition (n = 2), radial artery patch (n = 1), superficial temporal artery interposition graft (n = 1), superior thyroid artery interposition graft (n = 1), direct reimplantation of branch (n = 1), and reconstruction of trifurcation (n = 1). There was no mortality. Six patients had excellent outcomes with Glasgow Outcome Scale scores of 5, and one patient had a good outcome with a Glasgow Outcome Scale score of 4. Techniques for middle cerebral artery reconstruction may remain important and useful in the age of endovascular aneurysm treatment.

Surgical management of complex middle cerebral artery aneurysms.

Complex middle cerebral artery (MCA) aneurysms are defined in this review as aneurysms larger than 20 mm, arising from the MCA bifurcation, and requiring unusual surgical approaches for their obliteration. The direct surgical approaches to complex MCA aneurysms can be divided into five techniques: 1) direct clipping, 2) trapping, 3) trapping and extracranial-intracranial anastomosis, 4) excision and end-to-end anastomosis, and 5) external wrapping. The pertinent surgical anatomy, preoperative preparation, intraoperative procedures, operative approaches, and potential complications will be reviewed.