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| Name | Microsurgical Treatment of Fusiform Middle Cerebral Artery Aneurysms: Technique |
| Video Uploader | Video From NEUROSURGERY Journal |
| Upload Date | This Video Uploaded At 06-09-2013 14:18:58 |
| Video Discription | Fusiform and dolichoectatic aneurysms are rare and frequently not amenable to endovascular intervention due to the absence of a defined neck and presence of perforators that arise directly from the aneurysm. They can be large, sometimes giant, making exposure and microsurgical manipulation difficult. Calcification and atherosclerosis of the walls can further complicate clip ligation. Strategies for their microsurgical management include: clip reconstruction of the parent vessel (including aneurysmorrhaphy in giant types causing mass effect), aneurysm resection or trapping along with revascularization procedures, and wrapping with muslin if none of these strategies are feasible. Sometimes hypothermic circulatory arrest is necessary. This 3-D video demonstrates primary clip ligation/reconstruction of a large fusiform middle cerebral artery aneurysm. The patient, a 51-year-old woman, was diagnosed with this aneurysm on an MRI to evaluate chronic headaches. A standard pterional approach was used. The Sylvian fissure was opened to provide proximal and distal control of the fusiform M1 segment. Temporary M1 proximal occlusion allowed initial permanent clip application, which caused significant stenosis of the parent M1 vessel. The initial permanent clip was removed and the aneurysm was trapped, punctured, and deflated using a 25-gauge needle attached to suction. This allowed permanent clip placement and reconstruction of the M1 lumen without compromise of the M1 segment due to clip slippage. Indocyannin Green and fluorescein videoangiography confirmed patency of the parent vessel, associated perforators and complete aneurysm occlusion. Postoperative angiogram confirmed mild stenosis of the M1 segment with no flow restriction. The patient had no postoperative neurologic deficit. |
| Category | Science & Technology |
| Tags | MCA | aneurysm |
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