Your browser doesn't support javascript.
loading
Arterial Bypass in the Treatment of Complex Middle Cerebral Artery Aneurysms: Lessons Learned from Forty Patients.
Peeters, Sophie F; Colby, Geoffrey P; Kim, Wi Jin; Bae, Whi Inh; Sparks, Hiro; Reitz, Kara; Tateshima, Satoshi; Jahan, Reza; Szeder, Viktor; Nour, May; Duckwiler, Gary R; Vinuela, Fernando; Martin, Neil A; Wang, Anthony C.
Afiliación
  • Peeters SF; Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
  • Colby GP; Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University o
  • Kim WJ; Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
  • Bae WI; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
  • Sparks H; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
  • Reitz K; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
  • Tateshima S; Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
  • Jahan R; Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
  • Szeder V; Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
  • Nour M; Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
  • Duckwiler GR; Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
  • Vinuela F; Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
  • Martin NA; Department of Neurosurgery, Pacific Neuroscience Institute, Santa Monica, California, USA.
  • Wang AC; Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA. Electronic address: ACWang@mednet.ucla.edu.
World Neurosurg ; 181: e261-e272, 2024 Jan.
Article en En | MEDLINE | ID: mdl-37832639
ABSTRACT

OBJECTIVE:

Complex middle cerebral artery (MCA) aneurysms incorporating parent or branching vessels are often not amenable to standard microsurgical clipping or endovascular embolization treatments. We aim to discuss the treatment of such aneurysms via a combination of surgical revascularization and aneurysm exclusion based on our institutional experience.

METHODS:

Thirty-four patients with complex MCA aneurysms were treated with bypass and aneurysm occlusion, 5 with surgical clipping or wrapping only, and 1 with aneurysm excision and primary reanastomosis. Bypasses included superficial temporal artery (STA)-MCA, double-barrel STA-MCA, occipital artery-MCA, and external carotid artery-MCA. After bypass, aneurysms were treated by surgical clipping, Hunterian ligation, trapping, or coil embolization.

RESULTS:

The average age at diagnosis was 46 years. Of the aneurysms, 67% were large and most involved the MCA bifurcation. Most bypasses performed were STA-MCA bypasses, 12 of which were double-barrel. There were 2 wound-healing complications. All but 2 of the aneurysms treated showed complete occlusion at the last follow-up. There were 3 hemorrhagic complications, 3 graft thromboses, and 4 ischemic insults. The mean follow-up was 73 months. Of patients, 83% reported stable or improved symptoms from presentation and 73% reported a functional status (Glasgow Outcome Scale score 4 or 5) at the latest available follow-up.

CONCLUSIONS:

Cerebral revascularization by bypass followed by aneurysm or parent artery occlusion is an effective treatment option for complex MCA aneurysms that cannot be safely treated by standard microsurgical or endovascular techniques. Double-barrel bypass consisting of 2 STA branches to 2 MCA branches yields adequate flow replacement in most cases.
Asunto(s)
Palabras clave
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aneurisma Intracraneal / Revascularización Cerebral Límite: Humans / Middle aged Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aneurisma Intracraneal / Revascularización Cerebral Límite: Humans / Middle aged Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos