Browse
Submit Data
Databases
API
Help

Dataset Information

0 Views

0 Connections

0 Citations

0 Reanalyses

0 Downloads

Omics score: 0

Surgical repair of torn base of ruptured middle cerebral artery trifurcation aneurysm.

ABSTRACT:

Background

Treating complex middle cerebral artery (MCA) trifurcation aneurysms requires a delicate balance between achieving aneurysm obliteration and preserving vascular integrity. Various cerebral revascularization techniques, including bypass, and clip reconstruction are considered individually or in combination.

Methods

This case report outlines a successful repair of a ruptured neck and base of MCA trifurcation aneurysm using a suturing-clip reconstruction technique. Temporary aneurysm trapping was implemented, with maintained elevated blood pressure to ensure collateral perfusion during repair of ruptured base and neck of MCA aneurysm.

Conclusion

The suturing-clip reconstruction exhibited long-term radiological stability, emerging as a valuable alternative for managing challenging MCA trifurcation aneurysms.

SUBMITTER: Zhang R

PROVIDER: S-EPMC10961288 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Json Xml

Publications

Surgical repair of torn base of ruptured middle cerebral artery trifurcation aneurysm.

Zhang Rui R Muhammad Sajjad S

Acta neurochirurgica 20240325 1

<h4>Background</h4>Treating complex middle cerebral artery (MCA) trifurcation aneurysms requires a delicate balance between achieving aneurysm obliteration and preserving vascular integrity. Various cerebral revascularization techniques, including bypass, and clip reconstruction are considered individually or in combination.<h4>Methods</h4>This case report outlines a successful repair of a ruptured neck and base of MCA trifurcation aneurysm using a suturing-clip reconstruction technique. Tempora ...[more]

PMID: 38523166

Similar Datasets

Pseudoaneurysm Formation in Intracerebral Hematoma due to Ruptured Middle Cerebral Artery Aneurysm.

Project description:We report the case of a ruptured middle cerebral artery aneurysm that showed pseudoaneurysm formation in an intracerebral hematoma. A 61-year-old man who was taking warfarin complained of dysarthria. Three days later, he was found unconscious, and computed tomography on admission showed subarachnoid hemorrhage and an intracerebral hematoma in the left temporal lobe. Three-dimensional computed tomographic angiography showed an irregular-shaped aneurysm-like cavity extending from the left middle cerebral artery into the hematoma. Intraoperative observation revealed that the aneurysm itself was small and the lesion observed on computed tomography was a pseudoaneurysm that had formed in the hematoma. Pathologic examination of the aneurysm demonstrated that there was a thrombus at its tip. In this report, radiologic characteristics of three-dimensional computed tomographic angiography and etiology of a pseudoaneurysm in an intracerebral hematoma due to aneurysm rupture are discussed.

| S-EPMC5530621 | biostudies-other

Ruptured aneurysm associated with a twig-like middle cerebral artery: An illustrative case report.

Project description:BackgroundAnomalies of the middle cerebral artery (MCA) are rare; among the different types of anomalies, the aplastic or twig-like (Ap/T) MCA is extremely rare and has been reported under various names, including aplastic, unfused, or rete type anomaly. The occurrence of a brain aneurysm associated with this anatomic variant is an even rare event, and probably their development and rupture are related to hemodynamic stress of the tinny wall of vessels forming the network.Case descriptionWe present a 43-year-old male patient with an explosive and persistent right orbitofrontal headache. A computed tomography showed a right frontobasal hematoma with intraventricular disruption. Magnetic resonance angiography showed a right MCA aneurysm and what seems to be a MCA trunk stenosis. Cerebral digital subtraction angiography demonstrated a plexiform arterial network and one aneurysm arising from the network. The patient was successfully treated by surgical clipping to evacuate the hematoma and to prevent further intracranial hemorrhages.ConclusionThe Ap/T-MCA may be associated with hemodynamic stress with a significant effect through the tinny wall of the vessels causing hemorrhage or leading to the formation and rupture of cerebral aneurysms. Based on a correct diagnosis of the anomaly, treatment can be completed successfully through different standard methods.

| S-EPMC9610211 | biostudies-literature

Patient Outcomes and Cerebral Infarction after Ruptured Anterior Communicating Artery Aneurysm Treatment.

Project description:Background and purposeAnterior communicating artery aneurysm rupture and treatment is associated with high rates of dependency, which are more severe after clipping compared with coiling. To determine whether ischemic injury might account for these differences, we characterized cerebral infarction burden, infarction patterns, and patient outcomes after surgical or endovascular treatment of ruptured anterior communicating artery aneurysms.Materials and methodsWe performed a retrospective cohort study of consecutive patients with ruptured anterior communicating artery aneurysms. Patient data and neuroimaging studies were reviewed. A propensity score for outcome measures was calculated to account for the nonrandom assignment to treatment. Primary outcome was the frequency of frontal lobe and striatum ischemic injury. Secondary outcomes were patient mortality and clinical outcome at discharge and at 3 months.ResultsCoiled patients were older (median, 55 versus 50 years; P = .03), presented with a worse clinical status (60% with Hunt and Hess Score >2 versus 34% in clipped patients; P = .02), had a higher modified Fisher grade (P = .01), and were more likely to present with intraventricular hemorrhage (78% versus 56%; P = .03). Ischemic frontal lobe infarction (OR, 2.9; 95% CI, 1.1-8.4; P = .03) and recurrent artery of Heubner infarction (OR, 20.9; 95% CI, 3.5-403.7; P < .001) were more common in clipped patients. Clipped patients were more likely to be functionally dependent at discharge (OR, 3.2; P = .05) compared with coiled patients. Mortality and clinical outcome at 3 months were similar between coiled and clipped patients.ConclusionsFrontal lobe and recurrent artery of Heubner infarctions are more common after surgical clipping of ruptured anterior communicating artery aneurysms, and are associated with poorer clinical outcomes at discharge.

| S-EPMC7963583 | biostudies-literature

Double bypass for mycotic middle cerebral artery aneurysm.

Project description:BackgroundRuptured intracranial mycotic aneurysms have high morbidity and mortality and present unique surgical challenges because of vessel friability.[1] Flow-preserving strategies are needed for more proximal lesions that cannot be treated with vessel sacrifice.Case descriptionA 33-year-old man with no medical history who presented with fevers and peripheral septic emboli was found to have infective cardiac valve vegetations. He reported headaches and left arm weakness; an irregular 7 × 8 × 9 mm bilobed middle cerebral artery mycotic aneurysm involving multiple M3 branches with subarachnoid hemorrhage was found on cranial imaging. Multifocal and small intraparenchymal hemorrhages from septic emboli were also seen. Clip trapping and revascularization were recommended. A right frontotemporal craniectomy was performed, preserving the superficial temporal artery. After extradural exposure, a hole was drilled in the middle fossa floor lateral to the foramen ovale. The Sylvian fissure was split and the larger M3 branch was isolated. An endoscopically harvested saphenous vein graft was anastomosed to the cervical external carotid artery, tunneled through the middle fossa floor, and anastomosed end-to-side to the larger M3. The aneurysm was clip trapped and the involved smaller M3 was transected and anastomosed end-toend to the superficial temporal artery. Indocyanine green videoangiography confirmed patency of both bypasses. Postoperatively, the patient received antibiotics and a mitral valve replacement. He was neurologically intact on 1-month and 2-year follow-up.ConclusionAlthough technically demanding, tailored revascularization and clipping of ruptured mycotic cerebral aneurysms are a viable treatment option for these complex lesions.

| S-EPMC9479689 | biostudies-literature

Clipping of a ruptured middle cerebral artery aneurysm in a patient with coronavirus disease 2019 (COVID-19): A case report.

Project description:Aim of the studyThe aim of this study is to present our suggestions for organization, personal protective equipment (PPE) use, work flow of the operating theater, and the treatment of patients with COVID-19 and co-existing neurological disease.Materials and methodsWe present the case of a 70-year-old male who was transferred to our Department because of subarachnoid hemorrhage with ruptured right middle cerebral artery aneurysm and SARS CoV-2 infection. The emergency clipping of the aneurysm and hematoma evacuation was performed. According to the therapeutic committee guidelines, chloroquine was started for COVID-19 treatment.ResultsPostoperatively, the patient is in good condition, with the Glasgow Coma Scale (GCS) score of 15, with mild, left hemiparesis, 4+/5 points on the Lovett scale, without symptoms of acute respiratory distress syndrome (ARDS). No one from the stuff was infected during the treatment.ConclusionsManaging patients with infectious diseases such as COVID-19 presents many challenges and risks for healthcare personnel. Our experience suggests that by following strict safety protocols of PPE use, donning and doffing, and reducing operation time, the surgery may be safe for both the healthcare personnel and the patient.

| S-EPMC7387265 | biostudies-literature

Ruptured mycotic coronary artery aneurysm hybrid treatment with covered stent and surgical debridement☆

Project description: Not available

| S-EPMC10562108 | biostudies-literature

Fatal Ruptured Blood Blister-like Aneurysm of Middle Cerebral Artery Associated with Ehlers-Danlos Syndrome Type VIII (Periodontitis Type).

Project description:Objective To illustrate a unique instance of Ehlers-Danlos syndrome type VIII (EDS VIII) with blood blister-like aneurysm of the middle cerebral artery. Design This is a single patient case report. Setting University of Wisconsin-Madison Hospital. Participants A 42-year-old woman with diagnosis of EDS VIII presented with a sudden onset severe headache and altered mental status. She was diagnosed with Hunt and Hess grade IV subarachnoid hemorrhage. Angiography demonstrated a blood blister-like aneurysm of the left middle cerebral artery. After an unsuccessful coiling attempt in another facility, the patient was operated on with the intention to perform extracranial to intracranial bypass and trapping of the diseased segment of the artery. Results The patient's neurologic condition remained poor after surgery. On postoperative day 2, her neurologic examination unchanged, and care was withdrawn per the family's request. Conclusions Individuals with EDS VIII may be at risk for catastrophic vascular events.

| S-EPMC4242822 | biostudies-other

Emergent surgical embolectomy for middle cerebral artery occlusion related to cerebral angiography followed by neck clipping for an unruptured aneurysm in the anterior communicating artery.

Project description:BackgroundIntracranial embolism related to cerebral angiography is rare but one of the complications of the procedure. However, the standard management of acute intracranial embolism for this etiology has not been established, and there have been very few reports in the past.Case descriptionA 68-year-old male was incidentally found to have an unruptured aneurysm of anterior communicating artery (ACoA). Immediately after the cerebral angiography for the purpose of detailed examination of the aneurysm, the right partial hemiparalysis and mild aphasia developed. Magnetic resonance imaging/angiography (MRI/A) revealed an occlusion in the peripheral part of the left middle cerebral artery (MCA). Due to the existence of magnetic resonance angiography-diffusion mismatch, emergent craniotomy was immediately performed to remove intra-arterial thrombus. We also performed clipping for an unruptured ACoA aneurysm with this approach. Postoperative MRI/A showed that the occluded artery was recanalized and a slight infarction was observed in the left cerebral hemisphere. The patient was discharged on foot and followed at outpatient clinic over 4 years without no neurological deficit.ConclusionEmergent surgical embolectomy for distal MCA occlusion related to cerebral angiography followed by neck clipping for an unruptured aneurysm of the ACoA was successful in treating acute occlusion of the peripheral part of the MCA in a patient with an unruptured aneurysm. As there are few similar cases, there is controversy about the best management, but this surgical method can be a safe and effective treatment.

| S-EPMC7749952 | biostudies-literature

Massive intracerebral hemorrhages due to peripheral middle cerebral artery aneurysm rupture: A case report with a surgical video.

Project description:BackgroundSaccular aneurysm in the distal segment of the middle cerebral artery (DMCA) occurs very rarely and often represents with a rupture. We report a successful surgical case of a DMCA aneurysm rupture with large cerebral and subarachnoid hemorrhage.Case descriptionA 44-year-old female presented a sudden onset headache and coma (the Glasgow Coma Scale was 3). Head computed tomography (CT) revealed a subarachnoid hemorrhage around the right Sylvian fissure and large intracranial hematoma in the right parietal lobe. The CT angiography showed a saccular aneurysm in the peripheral cortical segment of the right angular branch of the right DMCA. We decided to perform a right craniotomy to evacuate hematoma and interrupt the aneurysm. Just after the dural incision, the aneurysm ruptured again. We applied a temporary clip on the artery proximal to the aneurysm before excising it.ConclusionAneurysm in DMCA can be treated safely with surgical excision and risk of sudden recurrent hemorrhage needs to be anticipated.

| S-EPMC8422445 | biostudies-literature

Adverse intraoperative events during surgical repair of ruptured cerebral aneurysms: a systematic review.

Project description:Compared with endovascular techniques, clipping of ruptured cerebral aneurysms has been shown to associate with increased morbidity in several studies. Despite this, clipping remains the preferred option for many aneurysms. The objective of this study is to describe the reported adverse events of open repair of ruptured cerebral aneurysms and their impact on patient outcome. The PubMed, Embase and Cochrane databases were searched between June 1999 and June 2019 to identify original studies of at least 100 patients undergoing surgical repair of ruptured cerebral aneurysms and in which adverse event rates were reported. Thirty-six studies reporting adverse events in a total of 12,410 operations for repair of ruptured cerebral aneurysms were included. Surgical adverse events were common with 36 event types reported including intraoperative rupture (median rate of 16.6%), arterial injury (median rate of 3.8%) and brain swelling (median rate 5.6%). Only 6 surgical events were statistically shown to associate with poor outcomes by any author and for intraoperative rupture (the most frequently analysed), there was an even split between authors finding a statistical association with poor outcome and those finding no association. Even with modern surgical techniques, the technical demands of surgical aneurysm repair continue to lead to a high rate of intraoperative adverse events. Despite this, it is not known which of these intraoperative events are the most important contributors to the poor outcomes often seen in these patients. More research directed towards identifying the events that most drive operative morbidity has the potential to improve outcomes for these patients.

| S-EPMC8121724 | biostudies-literature

OmicsDI is part of the ELIXIR infrastructure

OmicsDI is an Elixir interoperability service. Learn more ›

Tweets

OmicsDI Databases

PRIDE
PeptideAtlas
MassIVE
JPOST Repository
Physiome Model Repository

EGA
EVA
ENA
LINCS
PAXDB
Cell Collective

MetaboLights
Metabolomics Workbench
MetabolomeExpress
GNPS
BioModels
FAIRDOMHub

ArrayExpress
dbGaP
ExpressionAtlas
GEO
NODE

Information

Databases
Help
API
Contact us
Code on GitHub
Terms of use
Submit Data