BACKGROUND: Distal middle cerebral artery aneurysms originate from branches of MCA distal to its main bifurcation or the peripheral branches. Distal middle cerebral artery aneurysms are the least frequently seen among the middle cerebral artery aneurysms. The purpose of this article is to review the practical anatomy, preoperative planning, and avoidance of complications in the microsurgical dissection and clipping of MdistAs. METHODS: This review, and the whole series on intracranial aneurysms, are mainly based on the personal microneurosurgical experience of the senior author (JH) in 2 Finnish centers (Helsinki and Kuopio), which serve without patient selection the catchment area in Southern and Eastern Finland. RESULTS: These 2 centers have treated more than 10000 aneurysm patients since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients with 4253 aneurysms, 69 patients carrying altogether 78 MdistAs formed 5% of all MCA aneurysms. Among the 18 patients with ruptured MdistAs (23%), an ICH occurred in 9 (50%). CONCLUSIONS: Distal middle cerebral artery aneurysms are rare. The microneurosurgical treatment of MdistAs is challenging. They are often difficult to localize during the operation, and lack of collateral circulation makes their occlusion more demanding. High rate of ICH and high tendency of rebleeding urge acute or emergency surgery in most of ruptured cases. Microneurosurgical clipping is the most effective treatment of MdistAs.
BACKGROUND: Distal middle cerebral artery aneurysms originate from branches of MCA distal to its main bifurcation or the peripheral branches. Distal middle cerebral artery aneurysms are the least frequently seen among the middle cerebral artery aneurysms. The purpose of this article is to review the practical anatomy, preoperative planning, and avoidance of complications in the microsurgical dissection and clipping of MdistAs. METHODS: This review, and the whole series on intracranial aneurysms, are mainly based on the personal microneurosurgical experience of the senior author (JH) in 2 Finnish centers (Helsinki and Kuopio), which serve without patient selection the catchment area in Southern and Eastern Finland. RESULTS: These 2 centers have treated more than 10000 aneurysmpatients since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients with 4253 aneurysms, 69 patients carrying altogether 78 MdistAs formed 5% of all MCA aneurysms. Among the 18 patients with ruptured MdistAs (23%), an ICH occurred in 9 (50%). CONCLUSIONS: Distal middle cerebral artery aneurysms are rare. The microneurosurgical treatment of MdistAs is challenging. They are often difficult to localize during the operation, and lack of collateral circulation makes their occlusion more demanding. High rate of ICH and high tendency of rebleeding urge acute or emergency surgery in most of ruptured cases. Microneurosurgical clipping is the most effective treatment of MdistAs.
Authors: K Aydin; M Berdikhojayev; F Cay; M Barburoglu; S Nurzhan; S Aygun; S Sencer; A Arat Journal: AJNR Am J Neuroradiol Date: 2022-03-17 Impact factor: 3.825
Authors: Marcio L Tostes dos Santos; Antonio Ronaldo Spotti; Rosangela M Tostes dos Santos; Moacir Alves Borges; Antonio Fernandes Ferrari; Benedicto Oscar Colli; Waldir Antônio Tognola Journal: Neurosurg Rev Date: 2012-07-13 Impact factor: 3.042
Authors: J Marc C van Dijk; Rob J M Groen; Mark Ter Laan; Johanna Rinck Jeltema; Jan Jacob A Mooij; Jan D M Metzemaekers Journal: Acta Neurochir (Wien) Date: 2011-09-07 Impact factor: 2.216