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Hou K, Xu K, Liu H, Li G, Yu J. The Clinical Characteristics and Treatment Considerations for Intracranial Aneurysms Associated With Middle Cerebral Artery Anomalies: A Systematic Review. Front Neurol 2020; 11:564797. [PMID: 33193002 PMCID: PMC7654337 DOI: 10.3389/fneur.2020.564797] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background: As a result of their low incidence, most of the studies on intracranial aneurysms associated with middle cerebral artery (MCA) anomalies were presented as case reports or small case series. No systematic review on this specific entity has been conducted. Methods: A PubMed search of the published studies was performed on April 6th, 2019 for patients who had intracranial aneurysms associated with MCA anomalies. The languages included in this study were English, Chinese, and Japanese. Results: Finally, 58 articles reporting of 67 patients including 1 case in our center were included. The identified patients (37 females, 55.2%) aged from 4 to 81 (49.85 ± 15.22) years old. 50 (50/67, 74.6%) patients presented with hemorrhagic stroke either from the MCA anomalies associated aneurysms or other sources. 63 aneurysms (63/67, 94.0%) were saccular, 3 (4.5%) were dissecting or fusiform, and 1 (1.5%) was pseudoaneurysm. 32 (32/65, 49.2%) patients had other concurrent cerebrovascular anomalies. 56 (83.6%) patients underwent open surgeries, 8 (11.9%) patients underwent endovascular treatment, and 3 (4.5%) patients were conservatively managed. 56 (56/61, 91.8%) patients achieved a good recovery. Conclusions: The pathophysiological genesis of intracranial aneurysms associated with MCA anomalies is still obscure. The inflicted patients tend to have other concurrent cerebrovascular anomalies, which denotes that congenital defect in cerebrovascular development might play a role in this process. Most of the affected patients could experience a good recovery after treatment.
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Affiliation(s)
- Kun Hou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Hongping Liu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Guichen Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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Cooke J, Maingard J, Chandra RV, Slater LA, Brooks M, Asadi H. Acute middle cerebral artery stroke in a patient with a patent middle cerebral artery. Neurol Clin Pract 2019; 9:250-255. [PMID: 31341713 DOI: 10.1212/cpj.0000000000000605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/17/2018] [Indexed: 11/15/2022]
Abstract
Purpose of review Knowledge of cerebrovascular anatomical variants is vital for clinicians working with patients presenting with signs and symptoms of cerebral infarction, particularly in the era of endovascular clot retrieval. Recent findings We provide an overview of a cerebrovascular anatomical variation and detail a patient presenting with cerebral infarction secondary to occlusion of their anomalous vessel who underwent successful endovascular clot retrieval with excellent functional outcome. We also include technical descriptions. Summary Given the clinical importance of the areas supplied by the accessory middle cerebral artery, knowledge of this vessel is not only important for diagnosis but also for neurosurgical or endovascular management of patients with this variant.
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Affiliation(s)
- Jamie Cooke
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Julian Maingard
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ronil V Chandra
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lee-Anne Slater
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Mark Brooks
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Hamed Asadi
- Anatomy and Neuroscience (JC), School of Biomedical Sciences, University of Melbourne, Parkville; Department of Surgery (JC), Alfred Hospital, Melbourne, Victoria; Interventional Radiology Service (JM, MB, HA), Department of Radiology, Austin Hospital, Melbourne; School of Medicine (JM, MB, HA), Faculty of Health, Deakin University, Waurn Ponds; Stroke Division (JM, MB, HA), Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria; Interventional Neuroradiology Service (HA), Department of Radiology, St Vincent's Hospital; Interventional Neuroradiology Unit (RVC, L-AS, HA), Monash Imaging, Monash Health; and Faculty of Medicine (RVC, HA), Nursing and Health Sciences, Monash University, Melbourne, Australia
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Li K, Guo Y, Qu L, Xu B, Xu K, Yu J. Hybrid surgery for an arteriovenous malformation fed by an accessory middle cerebral artery and drained by a developmental venous anomaly: A case report and literature review. Exp Ther Med 2018; 16:1994-2000. [PMID: 30186430 PMCID: PMC6122327 DOI: 10.3892/etm.2018.6372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/21/2018] [Indexed: 11/05/2022] Open
Abstract
An accessory middle cerebral artery (AMCA), which mainly acts in the collateral circulation of the middle cerebral artery (MCA), is a rare anatomic malformation. Similar to other intracranial vessels, cerebrovascular disease can occur in the AMCA. However, the development of an arteriovenous malformation (AVM) in the AMCA is very rare, especially in conjuction with developmental venous anomalies (DVAs). Here, a rare case of an AMCA combined with an AVM and a DVA was reported. The patient was a 47-year-old female with intracranial hemorrhage at symptom onset. CT and MRI showed lesions in the left Sylvian fissure and insula accompanied by hemorrhage. DSA suggested a left AMCA; an AVM of the AMCA was located in the deep Sylvian fissure. The AVM was diffusely developed and drained into the DVA. The operation was performed in a hybrid operating room. The major feeding artery of the AVM, which was derived from the AMCA, was clipped, then the AVM and DVA were subsequently removed. Intraoperative DSA showed that the AVM and DVA were radically removed. A pathological examination confirmed the presence of an AVM. The patient recovered well and was discharged. Therefore, as highlighted in this case report, rare AVMs can be found in AMCAs and can even occur simultaneously with a DVA. Hybrid surgical treatment can be used to remove AVMs and can lead to an improved prognosis.
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Affiliation(s)
- Kailing Li
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Limei Qu
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Ghali MGZ, Srinivasan VM, Cherian J, Kim L, Siddiqui A, Aziz-Sultan MA, Froehler M, Wakhloo A, Sauvageau E, Rai A, Chen SR, Johnson J, Lam SK, Kan P. Pediatric Intracranial Aneurysms: Considerations and Recommendations for Follow-Up Imaging. World Neurosurg 2017; 109:418-431. [PMID: 28986225 DOI: 10.1016/j.wneu.2017.09.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pediatric intracranial aneurysms (IAs) are rare. Compared with adult IAs, they are more commonly giant, fusiform, or dissecting. Treatment often proves more complex, and recurrence rate and de novo aneurysmogenesis incidence are higher. A consensus regarding the most appropriate algorithm for following pediatric IAs is lacking. METHODS We sought to generate recommendations based on the reported experience in the literature with pediatric IAs through a thorough review of the PubMed database, discussion with experienced neurointerventionalists, and our own experience. RESULTS Digital subtraction angiography (DSA) was utilized immediately post-operatively for microsurgically-clipped and endovascularly-treated IAs, at 6-12 months postoperatively for endovascularly-treated IAs, and in cases of aneurysmal recurrence or de novo aneurysmogenesis discovered by non-invasive imaging modalities. Computed tomographic angiography was the preferred imaging modality for long-term follow-up of microsurgically clipped IAs. Magnetic resonance angiography (MRA) was the preferred modality for following IAs that were untreated, endovascularly-treated, or microsurgically-treated in a manner other than clipping. CONCLUSIONS We propose incidental untreated IAs to be followed by magnetic resonance angiography without contrast enhancement. Follow-up modality and interval for treated pediatric IAs is determined by initial aneurysmal complexity, treatment modality, and degree of posttreatment obliteration. Recurrence or de novo aneurysmogenesis requiring treatment should be followed by digital subtraction angiography and appropriate retreatment. Computed tomography angiography is preferred for clipped IAs, whereas contrast-enhanced magnetic resonance angiography is preferred for lesions treated endovascularly with coil embolization and lesions treated microsurgically in a manner other than clipping.
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Affiliation(s)
- Michael George Zaki Ghali
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Jacob Cherian
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Louis Kim
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - M Ali Aziz-Sultan
- Vascular and Endovascular Neurosurgery, Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Froehler
- Department of Neurology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Ajay Wakhloo
- Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Eric Sauvageau
- Baptist Neurological Institute, Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Ansaar Rai
- Department of Interventional Neuroradiology, West Virginia University, Morgantown, West Virginia, USA
| | - Stephen R Chen
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremiah Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Sandi K Lam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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