Document Detail

Extracranial-intracranial Bypass and Vessel Occlusion for the Treatment of Unclippable Giant Middle Cerebral Artery Aneurysms.
MedLine Citation:
PMID:  23208054     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Giant middle cerebral artery (MCA) aneurysms pose management challenges. OBJECTIVE:: To review the outcomes of patients with giant MCA aneurysms not amenable to clipping or vessel reconstruction treated with extracranial-intracranial (EC-IC) bypass and vessel sacrifice. METHODS:: We retrospectively reviewed a database of aneurysms treated at our institution between 1983 and 2011. RESULTS:: Sixteen patients (11 males, 5 females) were identified. There were 10 saccular, 4 fusiform, and 2 serpentine aneurysms. The aneurysms predominantly involved the M1 segment in 5 cases, M2 in 9 cases, and both M1 and M2 in 2 cases. The EC-IC bypasses performed included 13 STA-MCA, 1 saphenous vein graft (SVG-MCA), and 2 radial artery grafts (RAG-MCA). Postoperative bypass patency rate was 93.8% (15/16). There were three cerebrovascular accidents (18.8%), but no perioperative deaths (0% mortality). The mean follow-up was 58.4 months (range, 1-265; median, 23.5 months). In 75% (12/16) of cases the aneurysms were occluded successfully. A small residual was noted in three cases using this treatment strategy and they were retreated. In a fourth case treated with partial distal occlusion, reduced flow through the aneurysm was noted postoperatively, but the patient did not undergo further treatment. The mean modified Rankin scale (mRS) and mean Glasgow Outcome Scale (GOS) scores at last follow-up were 1.6 (range 1-4, median 1) and 4.8 (range 3-5, median 5), respectively. CONCLUSION:: Giant MCA aneurysms are challenging lesions. EC-IC bypass with parent vessel occlusion can provide a durable form of treatment with acceptable rates of morbidity and mortality.
M Yashar S Kalani; Joseph M Zabramski; Yin C Hu; Robert F Spetzler
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-30
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-12-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
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