Complex middle cerebral artery aneurysms: a new classification based on the angioarchitecture and surgical strategies

详细信息    查看全文

• 作者：Wei Zhu (1)
  Peixi Liu (1)
  Yanlong Tian (1)
  Yuxiang Gu (1)
  Bin Xu (1)
  Liang Chen (1)
  Liangfu Zhou (1)
  Ying Mao (1)
  
• 关键词：Middle cerebral artery ; Complex aneurysm ; Bypass surgery ; Clipping
• 刊名：Acta Neurochirurgica
• 出版年：2013
• 出版时间：August 2013
• 年：2013
• 卷：155
• 期：8
• 页码：1481-1491
• 全文大小：1012KB
• 参考文献：1. Alaraj A, Ashley WJ, Charbel FT, Amin-Hanjani S (2008) The superficial temporal artery trunk as a donor vessel in cerebral revascularization: benefits and pitfalls. Neurosurg Focus 24:E7 CrossRef
  2. Alaraj A, Ashley WJ, Charbel FT, Amin-Hanjani S (2008) The superficial temporal artery trunk as a donor vessel in cerebral revascularization: benefits and pitfalls. Neurosurg Focus 24:E7 CrossRef
  3. Amin-Hanjani S, Alaraj A, Charbel FT (2010) Flow replacement bypass for aneurysms: decision-making using intraoperative blood flow measurements. Acta Neurochir (Wien) Jun 152(6):1021-032, discussion 1032 CrossRef
  4. Babbu DR, Sano H, Kato Y, Arabi O, Karagiozov KL, Yoneda M, Imizu S, Watanabe S, Oda J, Kanno T (2006) The “Multi Clip-method in unruptured complex middle cerebral artery aneurysms–a case series. Minim Invasive Neurosurg 49:331-34 CrossRef
  5. Bederson JB, Zabramski JM, Spetzler RF (1992) Treatment of fusiform intracranial aneurysms by circumferential wrapping with clip reinforcement. Technical note. J Neurosurg 77:478-80 CrossRef
  6. Chen L, Lang L, Zhou L, Song D, Mao Y (2012) Bypass or not? Adjustment of surgical strategies according to motor evoked potential changes in large middle cerebral artery aneurysm surgery. World Neurosurg 77:391-98 CrossRef
  7. Choi IS, David C (2003) Giant intracranial aneurysms: development, clinical presentation and treatment. Eur J Radiol 46:178-94 CrossRef
  8. Drake CG, Peerless SJ (1997) Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg 87:141-62 CrossRef
  9. Gomes F, Dujovny M, Umansky F, Ausman JI, Diaz FG, Ray WJ, Mirchandani HG (1984) Microsurgical anatomy of the recurrent artery of Heubner. J Neurosurg 60:130-39 CrossRef
  10. Gomes FB, Dujovny M, Umansky F, Berman SK, Diaz FG, Ausman JI, Mirchandani HG, Ray WJ (1986) Microanatomy of the anterior cerebral artery. Surg Neurol 26:129-41 CrossRef
  11. Kimura T, Nishimura K, Fukaya S, Morita A (2010) Fusiform aneurysm of the anterior communicating artery treated by vascular reconstruction: case report. Neurosurgery 66:E1025–E1026 CrossRef
  12. Lanzino G, Spetzler RF (2003) Clip wrapping for partial avulsion of the aneurysm neck. Technical note. J Neurosurg 99:931-32 CrossRef
  13. Nakajima H, Kamiyama H, Nakamura T, Takizawa K, Tokugawa J, Ohata K (2012) Direct surgical treatment of giant middle cerebral artery aneurysms using microvascular reconstruction techniques. Neurol Med Chir (Tokyo) 52:56-1 CrossRef
  14. Rodriguez-Hernandez A, Sughrue ME, Akhavan S, Habdank-Kolaczkowski J, Lawton MT (2013) Current management of middle cerebral artery aneurysms: surgical results with a “clip first-policy. Neurosurgery 72(3):415-27. doi:10.1227/NEU.0b013e3182804aa2 CrossRef
  15. Romani R, Lehto H, Laakso A, Horcajadas A, Kivisaari R, von Und ZFM, Niemela M, Rinne J, Hernesniemi J (2011) Microsurgery for previously coiled aneurysms: experience with 81 patients. Neurosurgery 68(140-53):153-54
  16. Sanai N, Zador Z, Lawton MT (2009) Bypass surgery for complex brain aneurysms: an assessment of intracranial-intracranial bypass. Neurosurgery 65(670-83):683
  17. Sano H (2010) Treatment of complex intracranial aneurysms of anterior circulation using multiple clips. Acta Neurochir Suppl 107:27-1 CrossRef
  18. Seo BR, Kim TS, Joo SP, Lee JM, Jang JW, Lee JK, Kim JH, Kim SH (2009) Surgical strategies using cerebral revascularization in complex middle cerebral artery aneurysms. Clin Neurol Neurosurg 111:670-75 CrossRef
  19. Sughrue ME, Saloner D, Rayz VL, Lawton MT (2011) Giant intracranial aneurysms: evolution of management in a contemporary surgical series. Neurosurgery 69(1261-270):1270-271
  20. Sughrue ME, Saloner D, Rayz VL, Lawton MT (2011) Giant intracranial aneurysms: evolution of management in a contemporary surgical series. Neurosurgery 69(1261-270):1270-271
  21. van Doormaal TP, van der Zwan A, Verweij BH, Han KS, Langer DJ, Tulleken CA (2008) Treatment of giant middle cerebral artery aneurysms with a flow replacement bypass using the excimer laser-assisted nonocclusive anastomosis technique. Neurosurgery 63(12-0):20-2
  22. Waldron JS, Halbach VV, Lawton MT (2009) Microsurgical management of incompletely coiled and recurrent aneurysms: trends, techniques, and observations on coil extrusion. Neurosurgery 64(301-15):315-17
  23. Yang I, Lawton MT (2008) Clipping of complex aneurysms with fenestration tubes application and assessment of three types of clip techniques. Neurosurgery 62:S371–S378, 378-79 CrossRef
  
• 作者单位：Wei Zhu (1)
  Peixi Liu (1)
  Yanlong Tian (1)
  Yuxiang Gu (1)
  Bin Xu (1)
  Liang Chen (1)
  Liangfu Zhou (1)
  Ying Mao (1)
  
  1. Department of Neurosurgery, Huashan Hospital of Fudan University, 12 Wulumuqi zhong Road, Shanghai, 200040, China
  

文摘

Background Because of the diversity of aneurysm morphology, complicated arterial anatomy and hemodynamic characteristics, tailored surgical treatments are required for cases of individual complex middle cerebral artery (MCA) aneurysms. Methods During an 8-year period, 59 complex MCA aneurysms in 58 patients were treated microsurgically in our department. Complex aneurysms were defined as having large (10-4?mm in diameter) or giant (diameter?≥-5?mm) size or non-saccular morphology (fusiform, dissecting or serpentine). Results Direct clipping of the aneurysmal necks was achieved in eight patients, while reconstructive clipping was performed in 25 patients. Indirect aneurysm occlusion was performed in 25 cases, including trapping or resecting the aneurysm in four cases, trapping or resecting the aneurysm with extra-intracranial (EC) or intra-intracranial (IC) bypass in 21 cases and internal carotid artery (ICA) sacrifice with EC-IC bypass in one case. Forty-eight aneurysms (81.4?%) were completely obliterated. Graft patency was confirmed in 20 of 21 cases (95.2?%) with bypass. A recurrent aneurysm was detected in one case and a re-operation was performed. Two patients with Hunt-Hess grade IV aneurysms died during the perioperative period. Overall, 52 cases (88.1?%) had good outcomes (Glasgow Outcome Scale?≥-) during the late follow-up period. Conclusion The surgical modality and strategy for treating complex MCA aneurysm are decided according to the morphology of the aneurysm, vascular anatomy and the hemodynamic characteristics of each case. Thus, we developed a new classification based on the angioarchitecture. Favorable outcomes can be achieved by treating complex MCA aneurysms with appropriate surgical modalities, strategies and techniques.