Jung Cheol Park1, Jae Ho Shim2, Deok Hee Lee3, Jae Sung Ahn1, Dong-Geun Lee4, Kuhyun Yang5, Wonhyoung Park5, Hae-Won Koo5, Yuan Yuan Jiang6, Do Hoon Kwon1, Byung Duk Kwun1. 1. Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. 2. Department of Radiology, Ulsan Hospital, Ulsan, Korea. 3. Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: dhlee@amc.seoul.kr. 4. Department of Neurology, Sejong General Hospital, Bucheon, Korea. 5. Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. 6. Department of Medical Biotechnology, Dongguk University, Ilsan, Korea.
Abstract
BACKGROUND: For the treatment planning of a patient with a middle cerebral artery (MCA) trunk aneurysm, understanding the anatomic relationship among the aneurysm, branching vessels, and lenticulostriate arteries (LSAs) is important. We aimed to demonstrate the branching-vessel anatomy related to an MCA trunk aneurysm using 3-dimensional (3D) angiography. METHODS: We retrospectively reviewed 3D angiographic findings of 64 cases of MCA trunk aneurysms using a 3D workstation with various postprocessing conditions. We classified the aneurysms into 4 groups (early frontal cortical branch [EFCB], early temporal cortical branch [ETCB], LSA, and nonbranching aneurysms) and analyzed the relationship between the branching vessels and the LSAs. RESULTS: There were 30 EFCB aneurysms, 25 ETCB aneurysms, 7 LSA aneurysms, and 2 nonbranching aneurysms. Twenty-six (86.7%) of the 30 EFCB aneurysms shared common origins and were associated with the LSAs, but none of the 25 ETCB aneurysms were. Three of 24 patients who received clipping for an EFCB aneurysm experienced a postoperative infarction in the LSA territory. In these 3 patients, the LSA originated from the EFCB and was closely related with the aneurysm. CONCLUSIONS: We have identified a clinically important anatomic relationship between the MCA trunk aneurysm and branching vessels, including the LSAs. EFCB aneurysms show a close relationship with the LSAs. Pretreatment identification of the origin of the LSAs is important to obviate any perforator injury in EFCB aneurysms.
BACKGROUND: For the treatment planning of a patient with a middle cerebral artery (MCA) trunk aneurysm, understanding the anatomic relationship among the aneurysm, branching vessels, and lenticulostriate arteries (LSAs) is important. We aimed to demonstrate the branching-vessel anatomy related to an MCA trunk aneurysm using 3-dimensional (3D) angiography. METHODS: We retrospectively reviewed 3D angiographic findings of 64 cases of MCA trunk aneurysms using a 3D workstation with various postprocessing conditions. We classified the aneurysms into 4 groups (early frontal cortical branch [EFCB], early temporal cortical branch [ETCB], LSA, and nonbranching aneurysms) and analyzed the relationship between the branching vessels and the LSAs. RESULTS: There were 30 EFCBaneurysms, 25 ETCBaneurysms, 7 LSA aneurysms, and 2 nonbranching aneurysms. Twenty-six (86.7%) of the 30 EFCBaneurysms shared common origins and were associated with the LSAs, but none of the 25 ETCBaneurysms were. Three of 24 patients who received clipping for an EFCBaneurysm experienced a postoperative infarction in the LSA territory. In these 3 patients, the LSA originated from the EFCB and was closely related with the aneurysm. CONCLUSIONS: We have identified a clinically important anatomic relationship between the MCA trunk aneurysm and branching vessels, including the LSAs. EFCBaneurysms show a close relationship with the LSAs. Pretreatment identification of the origin of the LSAs is important to obviate any perforator injury in EFCB aneurysms.
Authors: K Murayama; S Suzuki; H Nagata; J Oda; I Nakahara; K Katada; K Fujii; H Toyama Journal: AJNR Am J Neuroradiol Date: 2019-12-19 Impact factor: 3.825