Surgical management of giant aneurysms of the middle cerebral artery

Ramachandra P. Tummala, Roberto Heros, Rishi N. Sheth, Mohamed Elhammady, Jacques Morcos

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

The middle cerebral artery (MCA) is the most common location for giant aneurysms of the anterior circulation. The contemporary management of giant aneurysms of the MCA lies largely in the surgical domain. Clipping is the first surgical option for these aneurysms. In about half the cases, the aneurysm neck is amenable to clipping, usually in conjunction with aneurysmorraphy. However, clipping is unsuitable for aneurysms without a well-defined neck or for fusiform giant aneurysms. For these cases, indirect treatment options include aneurysm trapping or proximal occlusion. Although frequently an M4 and occasionally an M3 branch can be sacrificed without the need for a distal bypass, we always recommend distal bypass whenever M1 or M2 must be sacrificed. There are several choices for distal bypass, but we prefer a high-flow bypass with a saphenous vein or radial artery graft whenever M1 is sacrificed and usually when M2 is occluded. With M3 or M4 occlusion, a low-flow superficial temporal artery distal bypass usually suffices. Recurring themes in the surgical treatment of these lesions are preservation of lenticulostriate perforators and keeping vessel reconstructions as simple as possible to reduce the length of temporary occlusion.

Original languageEnglish
Pages (from-to)85-92
Number of pages8
JournalOperative Techniques in Neurosurgery
Volume8
Issue number2
DOIs
StatePublished - Jun 1 2005

Fingerprint

Intracranial Aneurysm
Aneurysm
Temporal Arteries
Radial Artery
Saphenous Vein
Middle Cerebral Artery
Neck
Transplants

Keywords

  • Aneurysmorraphy
  • Aneurysms
  • Arterial occlusion
  • Bypass
  • Giant aneurysms
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Surgical management of giant aneurysms of the middle cerebral artery. / Tummala, Ramachandra P.; Heros, Roberto; Sheth, Rishi N.; Elhammady, Mohamed; Morcos, Jacques.

In: Operative Techniques in Neurosurgery, Vol. 8, No. 2, 01.06.2005, p. 85-92.

Research output: Contribution to journalArticle

Tummala, Ramachandra P. ; Heros, Roberto ; Sheth, Rishi N. ; Elhammady, Mohamed ; Morcos, Jacques. / Surgical management of giant aneurysms of the middle cerebral artery. In: Operative Techniques in Neurosurgery. 2005 ; Vol. 8, No. 2. pp. 85-92.
@article{23dc7af18d8d4e02b8fecbe6ff566618,
title = "Surgical management of giant aneurysms of the middle cerebral artery",
abstract = "The middle cerebral artery (MCA) is the most common location for giant aneurysms of the anterior circulation. The contemporary management of giant aneurysms of the MCA lies largely in the surgical domain. Clipping is the first surgical option for these aneurysms. In about half the cases, the aneurysm neck is amenable to clipping, usually in conjunction with aneurysmorraphy. However, clipping is unsuitable for aneurysms without a well-defined neck or for fusiform giant aneurysms. For these cases, indirect treatment options include aneurysm trapping or proximal occlusion. Although frequently an M4 and occasionally an M3 branch can be sacrificed without the need for a distal bypass, we always recommend distal bypass whenever M1 or M2 must be sacrificed. There are several choices for distal bypass, but we prefer a high-flow bypass with a saphenous vein or radial artery graft whenever M1 is sacrificed and usually when M2 is occluded. With M3 or M4 occlusion, a low-flow superficial temporal artery distal bypass usually suffices. Recurring themes in the surgical treatment of these lesions are preservation of lenticulostriate perforators and keeping vessel reconstructions as simple as possible to reduce the length of temporary occlusion.",
keywords = "Aneurysmorraphy, Aneurysms, Arterial occlusion, Bypass, Giant aneurysms, Subarachnoid hemorrhage",
author = "Tummala, {Ramachandra P.} and Roberto Heros and Sheth, {Rishi N.} and Mohamed Elhammady and Jacques Morcos",
year = "2005",
month = "6",
day = "1",
doi = "10.1053/j.otns.2005.09.002",
language = "English",
volume = "8",
pages = "85--92",
journal = "Operative Techniques in Neurosurgery",
issn = "1092-440X",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - Surgical management of giant aneurysms of the middle cerebral artery

AU - Tummala, Ramachandra P.

AU - Heros, Roberto

AU - Sheth, Rishi N.

AU - Elhammady, Mohamed

AU - Morcos, Jacques

PY - 2005/6/1

Y1 - 2005/6/1

N2 - The middle cerebral artery (MCA) is the most common location for giant aneurysms of the anterior circulation. The contemporary management of giant aneurysms of the MCA lies largely in the surgical domain. Clipping is the first surgical option for these aneurysms. In about half the cases, the aneurysm neck is amenable to clipping, usually in conjunction with aneurysmorraphy. However, clipping is unsuitable for aneurysms without a well-defined neck or for fusiform giant aneurysms. For these cases, indirect treatment options include aneurysm trapping or proximal occlusion. Although frequently an M4 and occasionally an M3 branch can be sacrificed without the need for a distal bypass, we always recommend distal bypass whenever M1 or M2 must be sacrificed. There are several choices for distal bypass, but we prefer a high-flow bypass with a saphenous vein or radial artery graft whenever M1 is sacrificed and usually when M2 is occluded. With M3 or M4 occlusion, a low-flow superficial temporal artery distal bypass usually suffices. Recurring themes in the surgical treatment of these lesions are preservation of lenticulostriate perforators and keeping vessel reconstructions as simple as possible to reduce the length of temporary occlusion.

AB - The middle cerebral artery (MCA) is the most common location for giant aneurysms of the anterior circulation. The contemporary management of giant aneurysms of the MCA lies largely in the surgical domain. Clipping is the first surgical option for these aneurysms. In about half the cases, the aneurysm neck is amenable to clipping, usually in conjunction with aneurysmorraphy. However, clipping is unsuitable for aneurysms without a well-defined neck or for fusiform giant aneurysms. For these cases, indirect treatment options include aneurysm trapping or proximal occlusion. Although frequently an M4 and occasionally an M3 branch can be sacrificed without the need for a distal bypass, we always recommend distal bypass whenever M1 or M2 must be sacrificed. There are several choices for distal bypass, but we prefer a high-flow bypass with a saphenous vein or radial artery graft whenever M1 is sacrificed and usually when M2 is occluded. With M3 or M4 occlusion, a low-flow superficial temporal artery distal bypass usually suffices. Recurring themes in the surgical treatment of these lesions are preservation of lenticulostriate perforators and keeping vessel reconstructions as simple as possible to reduce the length of temporary occlusion.

KW - Aneurysmorraphy

KW - Aneurysms

KW - Arterial occlusion

KW - Bypass

KW - Giant aneurysms

KW - Subarachnoid hemorrhage

UR - http://www.scopus.com/inward/record.url?scp=28844489399&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=28844489399&partnerID=8YFLogxK

U2 - 10.1053/j.otns.2005.09.002

DO - 10.1053/j.otns.2005.09.002

M3 - Article

AN - SCOPUS:28844489399

VL - 8

SP - 85

EP - 92

JO - Operative Techniques in Neurosurgery

JF - Operative Techniques in Neurosurgery

SN - 1092-440X

IS - 2

ER -