Management of giant middle cerebral artery aneurysms with incorporated branches: partial endovascular coiling or combined extracranial-intracranial bypass--a team approach

Neurosurgery
Zhong-Song ShiFernando Viñuela

Abstract

Our goal was to assess the long-term anatomic and clinical outcomes in patients with giant middle cerebral artery (MCA) aneurysms treated by endovascular coil embolization alone or in combination with cerebral revascularization. One hundred twenty-six patients with giant intracranial aneurysms were endovascularly treated at the University of California, Los Angeles, between 1990 and 2007. Of these, 9 patients had partially thrombosed MCA aneurysms with incorporated branches. Five patients presented with symptoms of mass effect, 3 had seizures, 2 had episodes of brain ischemia, and 1 presented with acute subarachnoid hemorrhage. Three wide-neck saccular aneurysms were almost completely coil occluded, leaving only small neck remnants that were intended to preserve the patency of incorporated MCA branches. The other 6 fusiform aneurysms were effectively treated by superficial temporal artery-MCA or occipital artery-MCA bypass, followed by complete coil occlusion of these aneurysms. Immediate angiograms and mid- or long-term neuroradiological imaging follow-up examinations revealed complete obliteration or near-complete occlusion (90%-99%) of the aneurysms in all 9 patients. Seven patients had a favorable long-term clinical outcome...Continue Reading

References

Nov 4, 2000·Neurosurgery·I B RossJ Moret
Jun 18, 2002·Journal of Neurosurgery·Gordon TangDaniel L Barrow
Apr 1, 2005·Neurosurgery·Laligam N SekharRamin Rak
Jun 17, 2006·Journal of Neurosurgery·Guglielmo PeroGiuseppe Scialfa
Jul 11, 2006·Neurosurgery·David FiorellaCameron G McDougall
Apr 21, 2007·Surgical Neurology·Reza DashtiJuha E Jääskeläinen

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