Giant fusiform aneurysm of the middle cerebral artery treated with extracranial-intracranial arterial bypass and Drake tourniquet

A giant fusiform aneurysm of the right middle cerebral artery was treated with extracranial-intracranial arterial bypass followed by controlled occlusion of the proximal parent artery using a Drake tourniquet. Thrombosis of the aneurysm is documented, with the distal extremity of the lesion being smoothly contrasted in a retrograde fashion by the hypertrophied bypass. The low risk as well as effectiveness of this combined approach to inaccessible intracranial aneurysms is confirmed.     

Giant fusiform aneurysm of the middle cerebral artery: successful Hunterian ligation without distal bypass

Giant fusiform aneurysm is a rare vascular lesion which presents difficult management issues. We describe one such aneurysm in a middle cerebral artery branch (M2) that presented with subarachnoid haemorrhage and was managed operatively. Clinical, radiological and pathological presentations, as well as the different treatment options for this type of aneurysm are discussed based on a literature review. A satisfactory results in an M2 giant fusiform aneurysm can be achieved with Hunterian ligation of the parent vessel even when a distal EC-IC bypass is not possible.     

Reflow into a thrombosed giant middle cerebral artery aneurysm after extracranial-intracranial bypass

This report graphically illustrates the consequences of flow augmentation through extracranial-intracranial bypass grafts. Propagation of clot from a thrombosed middle cerebral artery aneurysm into the middle cerebral artery produced transient ischemic attacks. Superficial temporal artery-middle cerebral artery bypass was performed to augment cerebral blood flow. Postoperative angiography demonstrated filling of the aneurysm through improved collateral channels. The role of bypass operation in the presence of an aneurysm and its contribution to collateral blood flow and clot lysis are discussed.     

Giant middle cerebral artery aneurysm with parent artery occlusion--case report.

A 54-year-old female was admitted with consciousness disturbance and right hemiparesis. Computed tomographic (CT) scans and angiograms revealed diffuse subarachnoid hemorrhage, a partially thrombosed, giant middle cerebral artery aneurysm (5 x 5 x 4 cm), and occlusion of the parent artery at the aneurysm site. Despite conservative treatment, a generalized convulsion occurred. Emergency CT scans revealed irregular enlargement of the left temporal high-density mass and severe mass effect due to cerebral infarction. Barbiturate coma therapy was administered, but she did not recover and died 9 days after admission. Only two cases of ruptured aneurysm with simultaneous occlusion of the major cerebral vessels have been reported, both with poor outcome. In this case, the mechanism of parent artery occlusion is unclear, but thrombus protrusion from the giant aneurysm into the parent artery may have been involved.     

Giant thrombosed vertebral artery aneurysm managed with extracranial-intracranial bypass surgery and aneurysmectomy. Case report.

A case is presented of a left giant thrombosed vertebral artery aneurysm in a 46-year-old man. The giant thrombosed aneurysm was successfully resected with trapping of the affected artery after right external carotid artery-posterior cerebral artery bypass surgery using a radial arterial graft. The clinical course is reported, and the details of the operative approach and techniques are discussed.     

Dissecting aneurysm of the posterior cerebral artery treated with proximal ligation.

A rare case of a dissecting aneurysm of the P3 segment of the right posterior cerebral artery is presented that seems to have occurred in association with mild head injury. The patient was treated surgically because of repeated intramural hemorrhage and enlargement of the aneurysm. Proximal ligation produced thrombosis of the aneurysm without resulting in infarction in the region of the posterior cerebral artery. The mechanisms of the dissection, diagnosis, and treatment are briefly discussed.     

Middle cerebral artery aneurysm due to Nocardia asteroides: case report of aneurysm excision and extracranial-intracranial bypass

Nocardia asteroides is an uncommon human pathogen typically encountered in immunocompromised patients. Primary central nervous system (CNS) nocardiosis is rare and usually manifests as cerebritis or abscesses. The case of a young woman who presented with CNS Nocardia abscesses complicated by an infective middle cerebral artery aneurysm is reported. Treatment, which included abscess aspiration, aneurysm excision, and end-to-end extracranial to intracranial bypass and prolonged antibiotic therapy, resulted in an excellent outcome. This case and the management of CNS nocardiosis are reviewed.     

Treatment of intraoperative middle cerebral artery occlusion with pentobarbital and extracranial-intracranial bypass. Case report.

A patient with a meningioma of the medial sphenoid wing underwent inadvertent intraoperative occlusion of the middle cerebral artery. Neurological deficit and infarction were presumably prevented by immediate administration of pentobarbital followed by extracranial-intracranial bypass.     

Giant fusiform middle cerebral aneurysm: successful treatment utilizing microvascular bypass.

A case of giant middle cerebral fusiform aneurysm is presented. The aneurysm was treated by superficial temporal-middle cerebral artery anastomosis and obliteration of the aneurysm by trapping. The application of extracranial to intracranial anastomosis to the problem is discussed.     

A ruptured middle cerebral artery aneurysm originating from the site of anastomosis 20 years after extracranial-intracranial bypass for moyamoya disease: case report

BACKGROUND: Direct revascularization through a superficial temporal artery-middle cerebral artery (STA-MCA) bypass is often performed to prevent ischemic or hemorrhagic attack in patients with moyamoya disease. This is the first reported case of aneurysm formation and rupture due to an STA-MCA bypass in a patient with moyamoya disease. CASE DESCRIPTION: A 52-year-old man who had undergone bilateral STA-MCA bypass for caudate hemorrhage due to moyamoya disease 20 years previously suffered from sudden-onset unconsciousness. Computed tomography revealed a massive intracerebral hematoma (ICH) in the left frontoparietal region. Angiography showed good patency of the anastomoses and stage IV moyamoya disease. However, no other abnormality was found. Emergency evacuation of the hematoma was performed. The patient's postoperative course was uneventful, but consciousness disturbance of sudden onset occurred 1 month later. Computed tomography showed a hematoma in the lateral ventricle and acute hydrocephalus. Repeat angiography revealed an aneurysm on the left side of the anastomosis. Bilateral ventricle drainage tubes were inserted, and the aneurysm was clipped. A ventriculoperitoneal shunt was later performed. CONCLUSION: In patients with moyamoya disease who have undergone extracranial-intracranial bypass surgery, progressive hemodynamic stress may cause the formation of de novo aneurysms after a postoperative period of several decades. Imaging examinations should therefore be performed periodically for follow-up, and a de novo aneurysm should be suspected in a patient who has an unusual ICH.     

Giant unruptured aneurysm of the middle cerebral artery manifesting with epilepsy: successful surgical treatment

A case of a giant aneurysm of the middle cerebral artery (M.C.A.), presenting with history of visual hallucinations, is described. The aneurysm was successfully excised, with disappearance of previous symptoms. The interest of the case is constituted by the very unfrequent location for an aneurysm over 3 cm in diameter, by the occurrence of epilepsy as the first symptom and by the excellent response to surgical therapy. The morphology and location of giant aneurysms, their surgical treatment and especially the problem of aneurysm-induced epilepsy are discussed.     

Ruptured aneurysm at a duplicated middle cerebral artery with accessory middle cerebral artery

Summary. Although many cerebral vascular anomalies are widely recognized, others are less well known or unclassified. Accessory middle cerebral artery (MCA) and duplicated MCA are among uncommon anomalies. We present a very rare case of subarachnoid haemorrhage due to rupture of a saccular aneurysm arising from a duplicated middle cerebral artery which was associated with an accessory middle cerebral artery.     

Giant aneurysm of the middle cerebral artery: angiographic analysis of blood flow.

The authors report a giant aneurysm of the middle cerebral artery with subarachnoid hemorrhage and without intraluminal thrombosis; by serial angiography, the turbulent blood flow within the aneurysm was demonstrated. The aneurysm was clipped successfully.     

Giant aneurysm of the middle cerebral artery presenting with complex partial seizure. Case report]

A 24-year-old female who had had several attacks of complex partial seizures was admitted after minor head trauma. There was no neurological deficit on admission, but a large oval calcification was incidentally found in the left temporal region on the plain skull film. Computed tomography scan and carotid angiography revealed a giant thrombosed aneurysm which arose from the M2 portion of the left middle cerebral artery. Focal spike discharges were found on the left temporal region on conventional electroencephalography. Left frontotemporal craniotomy and opening of the left sylvian fissure disclosed a giant aneurysm at the M2 portion of the left middle cerebral artery. The neck of the aneurysm was buried in the dome of the aneurysm and the parent artery was curved at an acute angle at the site of the neck. The aneurysm was excised and end-to-end anastomosis of the main stem of the M2 portion was successfully performed. Postoperative course was uneventful and the patient became completely free from seizures. The surgical technique and the possible mechanism of complex partial seizure in this patient are described.     

Ruptured distal middle cerebral artery aneurysm

OBJECT: Ruptured distal middle cerebral artery (MCA) aneurysms are uncommon, and their clinical and radiological features are poorly understood. To clarify characteristics of these lesions, the authors undertook a retrospective analysis of nine patients with ruptured distal MCA aneurysms. METHODS: The medical records of patients who underwent surgical repair of ruptured intracranial aneurysms between 1988 and 2002 at Shinshu University Hospital and its affiliated hospitals were retrospectively evaluated. The authors found only nine patients with a ruptured distal MCA aneurysm, and their clinical, neuroimaging, and intraoperative findings were evaluated. CONCLUSIONS: This study of nine patients with distal MCA aneurysms is the largest series to date. Eight lesions were saccular aneurysms that were clipped and the remaining one was a mycotic aneurysm that was trapped. Eight of the nine patients suffered cerebral hematomas with subarachnoid hemorrhage. All patients had good outcomes after obliteration of their aneurysm, although their preoperative condition was not good.