1
|
Hu P. Epidural Pretemporal Transcavernous Approach Double-Barrel Superficial Temporal Artery-Posterior Cerebral Artery/Superior Cerebellar Artery Bypass for a Ruptured Anterior Spinal Artery Aneurysm. Oper Neurosurg (Hagerstown) 2023; 24:e23-e28. [PMID: 36227207 DOI: 10.1227/ons.0000000000000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Rostral posterior circulation bypass is technically challenging. Pretemporal approach has been reported to facilitate the bypass procedure within the oculomotor-tentorial triangle. However, bridging veins converging into cavernous sinus at the temporal pole usually need to be sacrificed. OBJECTIVE To report operative nuances of rostral posterior circulation bypass with an emphasis on preserving the Sylvian veins and enlarging surgical space, we use a double-barrel superficial temporal artery-posterior cerebral artery/superior cerebellar artery anastomosis using an epidural pretemporal transcavernous approach. METHODS A 54-year-old man had a subarachnoid hemorrhage attack 1 month before the admission. A flow-related anterior spinal artery aneurysm with bilateral vertebral artery occlusive diseases was indicated. The aneurysm was difficult to be directly treated, either by the endovascular approach or by the microsurgical clipping. A double-barrel superficial temporal artery-superior cerebellar artery/posterior cerebral artery bypass was performed using an epidural pretemporal transcavernous approach. RESULTS The anastomoses were successfully accomplished in a large surgical space. The patient recovered well with no events, except a transient right cranial nerve III paralysis. The aneurysm was demonstrated to be completely regressed at the 5-month follow-up. CONCLUSION An epidural pretemporal transcavernous approach could be an alternative for rostral posterior circulation bypass.
Collapse
Affiliation(s)
- Peng Hu
- Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
2
|
Hong CK, Byun J, Park W, Kim YH, Park JC, Ahn JS, Kim JH. Management of Internal Carotid Artery Injury During Transsphenoidal Surgery: A Case Series and Suggestion for Optimal Management. World Neurosurg 2022; 163:e230-e237. [PMID: 35364296 DOI: 10.1016/j.wneu.2022.03.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Internal carotid artery (ICA) injury during transsphenoidal surgery is a rare but serious complication. We analyzed a series of ICA injuries that occurred during a transsphenoidal approach to suggest an optimal management strategy. METHODS Between January 2015 and May 2020, we enrolled 10 cases of ICA injury at our institution. RESULTS Among the 10 patients enrolled, 5 had pituitary adenoma, 2 had craniopharyngioma, and 1 each had skull base chondrosarcoma, tuberculum sellae meningioma, and nasopharyngeal cancer; 4 were revision surgery cases. The cavernous segment of the ICA was the most commonly injured area. The most common reason for ICA injury was a drill injury at the sellar floor opening. A direct repair was performed using a clip in only 1 patient. In the others, bleeding control of the injured ICA was achieved by packing multiple cotton pads. After angiography, 6 patients underwent immediate endovascular sacrifice of the injured ICA. In 3 patients who showed poor collateral flow from the anterior communicating and posterior communicating arteries, revascularization surgery was performed before endovascular trapping. After 6 postoperative months, 6 patients showed favorable functional outcomes, and 4 patients showed poor functional outcomes. CONCLUSIONS Prompt control of bleeding, endovascular management of injured ICA, and consideration of revascularization surgery based on collateral flow may prevent catastrophic neurological sequelae.
Collapse
Affiliation(s)
- Chang Ki Hong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joonho Byun
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neuro-intervention, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeong Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
3
|
Huang C, Qin S, Cao G, Huang W, Yu Y. Internal Maxillary Artery-Radial Artery-Middle Cerebral Artery Bypass and STA-MCA Bypass for the Treatment of Complex Middle Cerebral Artery Bifurcation Aneurysm: A Case Report. Front Surg 2022; 8:773371. [PMID: 35141269 PMCID: PMC8818776 DOI: 10.3389/fsurg.2021.773371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundChildren's complex middle cerebral artery (MCA) aneurysm is a relatively rare occurrence. When the huge aneurysm is located in the MCA bifurcation with an inconspicuous neck and involving numerous arteries, intravascular interventional surgery or aneurysm clipping are often difficult treatment options. At this point, high flow bypass revascularization is necessary as a treatment to preserve cerebral blood flow. In recent years, the internal maxillary artery (IMA) has gradually become the mainstream donor artery of thw high flow bypass. We performed internal maxillary artery -radial artery-middle cerebral artery (IMA-RA-MCA) and superficial temporal artery-middle cerebral artery (STA-MCA) bypass as the treatment of a complex MCA bifurcation aneurysm in consideration of the patient's condition and the advantage of the IMA. According to the author, this case is the youngest reported case of IMA-RA-MCA bypass at present.Case DescriptionA male child, 7 years and 8 months, was admitted to the hospital due to “recurrent headache for more than 9 months,” DSA indicated that there was a large wide-necked aneurysm at the bifurcation of the right MCA M1 segment, with a size of about 1.16*1.58*1.32 cm. The inflow path of the aneurysm was in front of M1 bifurcation, and one outflow path originated from the aneurysm body, and another small outflow path attached to the aneurysm body. After completing the preoperative evaluation, an extended pterional approach with zygomatic osteotomy was performed to fully expose the aneurysm and IMA, harvesting the left radial artery at the same time, then a STA-MCA bypass, IMA-RA-MCA bypass, and aneurysm trapping were performed. postoperative re-examination showed that bypass vessels and the distal middle artery vessels were patent and the aneurysm disappeared, the child has no neurological dysfunction.ConclusionsIMA-RA-MCA bypass is an effective high-flow cerebral blood reconstruct scheme in the treatment of complex middle cerebral artery bifurcation aneurysms. This case can provide a reference for the surgical treatment of complex middle cerebral artery bifurcation aneurysms in children.
Collapse
|
4
|
Giant Middle Cerebral Artery Aneurysms: A 55-Patient Series. World Neurosurg 2021; 155:e727-e737. [PMID: 34492390 DOI: 10.1016/j.wneu.2021.08.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The treatment of middle cerebral artery (MCA) giant aneurysms (GAs) represents a challenging task. METHODS The data for 55 patients treated for MCA GA (≥25 mm) at the N.N. Burdenko NMRCN between 2010 and 2019 were analyZed. RESULTS The GAs were located in the M1 segment in 11 (20%) patients, MCA bifurcation in 33 (60%), M2 in 7 (12.7%), and M3 in 4 (7.3%). There were 32 (58.2%) saccular and 23 (41.8%) fusiform GAs. MCA GAs were treated with neck clipping (50.9%), clipping with the artery lumen formation (3.6%), bypass surgeries (34.5%), wrapping (3.6%), and endovascular surgery (7.3%). A worsening of the neurologic state in the perioperative period was observed in 50.9% of patients. The complete closure of GA was achieved in 78.2%. Surgery-related mortality was 1.8%. The long-term outcome was favorable in 76.9% of patients. Surgery-related and disease-related plus treatment failures-related mortality was 9.6%. CONCLUSIONS Microsurgical clipping and bypass surgery are the main operative interventions for MCA GA treatment. These operations are technically complex and are followed by a relatively high percentage of complications. The main tasks that require further investigations are the introduction of new precise diagnostic methods for the collateral circulation assessment in the cortical MCA branches, the perfection of the algorithm for the bypass selection, and investigation of the long-term results of the endovascular and combined treatments. It is of major importance to thoroughly observe the patients long-term after the surgery and ensure the possibility for further angiographic studies.
Collapse
|
5
|
Asimakidou E, Abut PA, Raabe A, Seidel K. Motor Evoked Potential Warning Criteria in Supratentorial Surgery: A Scoping Review. Cancers (Basel) 2021; 13:2803. [PMID: 34199853 PMCID: PMC8200078 DOI: 10.3390/cancers13112803] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 12/31/2022] Open
Abstract
During intraoperative monitoring of motor evoked potentials (MEP), heterogeneity across studies in terms of study populations, intraoperative settings, applied warning criteria, and outcome reporting exists. A scoping review of MEP warning criteria in supratentorial surgery was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Sixty-eight studies fulfilled the eligibility criteria. The most commonly used alarm criteria were MEP signal loss, which was always a major warning sign, followed by amplitude reduction and threshold elevation. Irreversible MEP alterations were associated with a higher number of transient and persisting motor deficits compared with the reversible changes. In almost all studies, specificity and Negative Predictive Value (NPV) were high, while in most of them, sensitivity and Positive Predictive Value (PPV) were rather low or modest. Thus, the absence of an irreversible alteration may reassure the neurosurgeon that the patient will not suffer a motor deficit in the short-term and long-term follow-up. Further, MEPs perform well as surrogate markers, and reversible MEP deteriorations after successful intervention indicate motor function preservation postoperatively. However, in future studies, a consensus regarding the definitions of MEP alteration, critical duration of alterations, and outcome reporting should be determined.
Collapse
Affiliation(s)
- Evridiki Asimakidou
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
| | - Pablo Alvarez Abut
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
- Department of Neurosurgery, Clínica 25 de Mayo, 7600 Mar del Plata, Argentina
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
| | - Kathleen Seidel
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
| |
Collapse
|
6
|
Telles JPM, Solla DJF, Yamaki VN, Rabelo NN, da Silva SA, Caldas JGP, Teixeira MJ, Junior JR, Figueiredo EG. Comparison of surgical and endovascular treatments for fusiform intracranial aneurysms: systematic review and individual patient data meta-analysis. Neurosurg Rev 2020; 44:2405-2414. [PMID: 33205313 DOI: 10.1007/s10143-020-01440-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/14/2020] [Accepted: 11/12/2020] [Indexed: 12/29/2022]
Abstract
Fusiform intracranial aneurysms (FIA) are associated with significant morbidity and mortality. We carried out a systematic review and meta-analysis of individual participant data with propensity score adjustment to compare the functional and angiographic outcomes between surgical and endovascular approaches to FIA. We conducted a systematic review for articles on the treatment of FIA with individual patient-level detailing. Data from patients treated for FIA in our institution from 2010 to 2018 were also collected. The primary studied outcome was morbidity, and secondary outcomes were angiographic results and retreatment. Propensity score-adjusted mixed-effects logistic regression models evaluated treatment options, stratified by anatomical location. Compiling original and published data, there were 312 cases, of which 79 (25.3%) had open surgery, and 233 (74.5%) were treated with endovascular procedures. There were no differences between treatment groups, for neither cavernous ICA (OR 1.04, 95% CI 0.05-23.6) nor supraclinoid aneurysms (OR 7.82, 95% CI 0.65-94.4). Both size (OR 1.11, 95% CI 1.03-1.19) and initial mRS (OR 2.0, 95% CI 1.2-3.3) were risk factors for morbidity, independent of location. Neither age nor rupture status influenced the odds of posterior morbidity. Unfavorable angiographic outcomes were more common in the endovascular group for supraclinoid and vertebrobasilar aneurysms (χ2, P < 0.01). There were no differences between morbidity of surgical and endovascular treatments for FIA, regardless of aneurysm location. Size and initial mRS were correlated with functional outcomes, whereas age and rupture status were not. Microsurgery seems to yield better long-term angiographic results compared to endovascular procedures.
Collapse
Affiliation(s)
- João Paulo Mota Telles
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Davi Jorge Fontoura Solla
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Department of Interventional Neuroradiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vitor Nagai Yamaki
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nicollas Nunes Rabelo
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Saul Almeida da Silva
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Department of Interventional Neuroradiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Guilherme Pereira Caldas
- Department of Interventional Neuroradiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jefferson Rosi Junior
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Eberval Gadelha Figueiredo
- Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
7
|
Luzzi S, Gragnaniello C, Giotta Lucifero A, Del Maestro M, Galzio R. Surgical Management of Giant Intracranial Aneurysms: Overall Results of a Large Series. World Neurosurg 2020; 144:e119-e137. [PMID: 32949801 DOI: 10.1016/j.wneu.2020.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review and discuss surgical treatment options for giant intracranial aneurysms (GIAs), focusing on indications, technical aspects, and results, along with some illustrative cases. METHODS We reviewed the data of 82 consecutive patients surgically managed between January 2000 and December 2019 for treatment of a GIA. RESULTS Male sex and hemorrhage at presentation were prevalent. The average follow-up was 81.2 ± 45 months. The anterior circulation was involved in 76.8% of GIAs. If the GIA showed a clear neck, minimal atherosclerosis, or intrasaccular thrombosis, and ≤2 branches arising from the neck, it was reconstructed. This procedure was possible in 78% of cases. The technique also involved temporary clipping, remodeling, and thrombectomy, as well as fragmentation techniques. Angioarchitectural features other than these techniques underwent bypass and aneurysm trapping. Most bypasses were extracranial to intracranial and high flow. Flow capacity, collateral circulation, and availability of the donor vessel mainly affected the choice of the type of bypass. Overall, successful exclusion of the GIA was 91.4%. The need for retreatment and complication rate were 3.6% and 19.5%, respectively. A good overall outcome (modified Rankin Scale score 0-3) was achieved in 84.2% of patients, and mortality was 10%. CONCLUSIONS Microneurosurgical techniques still maintain a significant role for most GIAs, with a high durability and acceptable rate of morbidity and mortality. Clip reconstruction is the first-line surgical treatment option, whereas bypass is indicated in cases of planned or unplanned sacrifice of the parent artery to prevent long-term ischemic complications.
Collapse
Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Cristian Gragnaniello
- Department of Neurological Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mattia Del Maestro
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Renato Galzio
- Neurosurgery Unit, Maria Cecilia Hospital, Cotignola, Italy
| |
Collapse
|
8
|
Huynh TD, Felbaum DR, Jean WC, Ngo HM. Spontaneous Thrombosis of Giant Dissecting Fusiform Middle Cerebral Aneurysm After Double-Barrel Superficial Temporal Artery–Middle Cerebral Artery Bypass: A Case Report of Decision-Making in a Limited Resource Environment. World Neurosurg 2020; 136:161-168. [DOI: 10.1016/j.wneu.2020.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
|
9
|
Fluss R, Rahme R. Commentary: Combined Internal Maxillary Artery to Middle Cerebral Artery and In Situ Middle Cerebral to Middle Cerebral Artery Bypass for Complex Middle Cerebral Artery Aneurysm: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 18:E123-E124. [PMID: 31515563 DOI: 10.1093/ons/opz274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rose Fluss
- Division of Neurosurgery, SBH Health System, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Ralph Rahme
- Division of Neurosurgery, SBH Health System, Bronx, New York.,CUNY School of Medicine, New York, New York
| |
Collapse
|
10
|
Kim YS, Ha MH, Joo SP, Kim TS. Acute Parent Artery Occlusion in Thrombosed Middle Cerebral Artery Aneurysm Presenting with Ischemic Stroke. World Neurosurg 2020; 136:122-127. [PMID: 31953097 DOI: 10.1016/j.wneu.2020.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Thrombosed intracranial aneurysms are complex and unstable lesions that are especially associated with ischemic stroke. Although acute parent artery occlusion manifesting with ischemic stroke is very rare, it can lead to catastrophic consequences. CASE DESCRIPTION This study presents 2 cases of acute parent artery occlusion in thrombosed large and giant middle cerebral artery bifurcation aneurysms manifesting with ischemic stroke. Both patients were successfully treated with emergent double-barrel superficial temporal artery-to-middle cerebral artery bypass followed by aneurysm trapping. CONCLUSIONS Emergent superficial temporal artery-to-middle cerebral artery bypass could be a salvageable treatment option in patients with progressive neurologic deficits and significant mismatch between diffusion- and perfusion-weighted imaging in acute parent artery occlusions associated with large or giant thrombosed aneurysms. Besides diffusion- and perfusion-weighted imaging, preoperative assessment of the collaterals will help in predicting postoperative prognosis.
Collapse
Affiliation(s)
- You-Sub Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Myeong-Hun Ha
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Tae-Sun Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
| |
Collapse
|