Surgical Trapping of a Large Complex Middle Cerebral Artery Aneurysm With Double-Barrel Bypass: 3-Dimensional Operative Video
| Autor: | Amrit K Chiluwal, Amir R. Dehdashti, Mohsen Nouri, Denis Knobel |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Middle Cerebral Artery
medicine.medical_specialty medicine.medical_treatment Maxillary Artery Revascularization Magnetic resonance angiography 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aneurysm medicine.artery medicine Humans cardiovascular diseases Radial artery Cerebral Revascularization medicine.diagnostic_test business.industry Intracranial Aneurysm Maxillary artery Clipping (medicine) Superficial temporal artery medicine.disease Temporal Arteries Surgery Middle cerebral artery cardiovascular system Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Operative Neurosurgery. 20:E444-E445 |
| ISSN: | 2332-4260 2332-4252 |
| DOI: | 10.1093/ons/opab028 |
| Popis: | Large middle cerebral artery (MCA) bifurcation aneurysms are known vascular lesions that are usually symptomatic but often difficult to treat (whether with open or endovascular techniques), especially when the M2 branches originate from the aneurysm dome.1-7 The challenge lies in securing the aneurysm while fully maintaining the flow in the vessels arising from the dome. Standard microsurgical clipping or endovascular techniques are not feasible in perfectly treating these aneurysms. Revascularization of the MCA branches with bypass and trapping of the aneurysm is often necessary. Here, we present a case of a large complex partially thrombosed right MCA bifurcation aneurysm with both the superior and the inferior divisions arising from the dome. The patient initially presented with a right MCA stroke and left hemiparesis. Using radial artery as an interposition graft, 2 bypasses-internal maxillary artery to the inferior division and superficial temporal artery to the superior division-were performed. The aneurysm was trapped and decompressed by placing clips at the M1 terminus and the M2 origins. Intraoperative angiography and postoperative NOVA (VasSol Inc.) magnetic resonance angiography (MRA) confirmed patency and excellent flow in the bypass grafts. The patient's postoperative course was uncomplicated, and at 2-mo follow-up, had significant improvement of her hemiparesis. The patient provided informed consent for the procedure. |
| Databáze: | OpenAIRE |
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