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Middle cerebral artery aneurysm treatment

Treatment of unruptured middle cerebral artery aneurysm can be performed either endovascular or microsurgical, with a low risk of repair using both approaches.

The results of microsurgical treatment for middle cerebral artery (MCA) aneurysms (ANs) have been highly satisfying for decades, notoriously posing a challenge for interventional neuroradiologists. Following the International Subarachnoid Aneurysm Trial (ISAT) study results, most centres across Europe and the USA switched to a “coil first” policy.

In the series of Dammann et al the risk for incomplete occlusion was higher for the endovascular approach 1).

Surgical treatment

Craniotomy for hematoma evacuation and aneurysm clipping is the treatment modality of choice for ruptured middle cerebral artery (MCA) aneurysms with intracranial hematomas. Recent literature suggests that endovascular coil embolization followed by hematoma evacuation can be an acceptable alternative.

MCA aneurysm rupture with concomitant large intraparenchymal or sylvian fissure hematoma formation carries a grave prognosis. Simultaneous hematoma evacuation and aneurysm clipping with or without craniectomy can be an effective treatment modality 2).

Sylvian opening

A wide sylvian fissure opening, with either a proximal or distal start, has been standard for microsurgical management of middle cerebral artery (MCA) aneurysms. However, extensive sylvian dissection is potentially associated with increased incidence of iatrogenic injury to the brain and neurovascular structures.

The focused sylvian opening is a less-invasive alternative to the classical wide sylvian opening for the microsurgical management of most MCA aneurysms 3).

Through small temporal craniotomy and linear skin incision

There were no complications of temporal muscle atrophy, scar deformity, paresthesia, or pain around the scalp incision and frontalis palsy. This approach offers good surgical possibilities and little approach related morbidity in the clipping of incidental MCA aneurysms 4).

see Middle cerebral artery aneurysm endovascular treatment

Dammann P, Schoemberg T, Müller O, Ozkan N, Schlamann M, Wanke I, Sandalcioglu IE, Forsting M, Sure U. Outcome for unruptured middle cerebral artery aneurysm treatment: surgical and endovascular approach in a single center. Neurosurg Rev. 2014 Jul 9. [Epub ahead of print] PubMed PMID: 25005630.
Stapleton CJ, Walcott BP, Fusco MR, Butler WE, Thomas AJ, Ogilvy CS. Surgical management of ruptured middle cerebral artery aneurysms with large intraparenchymal or sylvian fissure hematomas. Neurosurgery. 2015 Mar;76(3):258-64. doi: 10.1227/NEU.0000000000000596. PubMed PMID: 25603109.
Elsharkawy A, Niemelä M, Lehečka M, Lehto H, Jahromi BR, Goehre F, Kivisaari R, Hernesniemi J. Focused opening of the sylvian fissure for microsurgical management of MCA aneurysms. Acta Neurochir (Wien). 2014 Jan;156(1):17-25. doi: 10.1007/s00701-013-1894-7. Epub 2013 Oct 8. PubMed PMID: 24101289.
Mun JH, Cho KY, Lee RS, Lim BC, Choi TM, Lim JS. Clipping of incidental aneurysm of middle cerebral artery through small temporal craniotomy and linear skin incision. J Cerebrovasc Endovasc Neurosurg. 2014 Mar;16(1):32-8. doi: 10.7461/jcen.2014.16.1.32. Epub 2014 Mar 31. PubMed PMID: 24765611.
middle_cerebral_artery_aneurysm_treatment.txt · Last modified: 2017/11/04 07:52 by administrador