ORIGINAL

Middle Cerebral Artery Aneurysms: microsurgical clipping and pitfalls. An overview

Aneurismas da Artéria Cerebral Média: clipagem e detalhes da técnica. Uma visão analítica

  • Pedro Henrique Simm Pires de Aguiar (1) (2)    Pedro Henrique Simm Pires de Aguiar (1) (2)
  • Giovanna Zambo Galafassi (3)
  • João Pedro Magalhães Farias (3)
  • Stephanie Borghi Campos de Moraes (3)
  • Marco Tulio Sette dos Santos (4)
  • Marco Prist (5)
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Resumo

Os autores revisaram os detalhes técnicos da clipagem microcirúrgica de aneurismas cerebrais médios não rotos. Os detalhes da dissecção são enfatizados, bem como as principais indicações. A discussão dos aspectos anatômicos foi desenvolvida e o tratamento endovascular também foi abordado nesta visão geral. A microcirurgia de aneurismas cerebrais continua sendo um desafio e todos os esforços para manter o conhecimento e os conceitos da abordagem microcirúrgica devem ser preservados, sendo este o objetivo principal deste artigo.

Palavras-chave

Aneurisma da artéria cerebral média; Clipagem microcirúrgica; Tratamento endovascular; Diversor de fluxo; Artéria cerebral média

Abstract

The authors reviewed the technical details of microsurgical clipping of non ruptured middle cerebral aneurysms. Details of the dissection are emphasized as well as the main indications. Discussion of anatomical aspects and landmarks was developed and the endovascular treatment was also concerned in this overview. The microsurgery of brain aneurysms remains a challenge and all efforts to keep the knowledge and concepts of microsurgical approach ought to be preserved, being the main goal of this article.

Keywords

Middle cerebral artery aneurysm; Microsurgical clipping; Endovascular treatment; Flow divert; Middle cerebral artery

References

1. Pires de Aguiar PH, Santana PA Jr, Panagopoulos AT, et al. Middle cerebral artery aneurysms: challenges for microsurgical approach. Rev Chil Neurocir. 2008;30:59-67.

2. Umansky F, Gomes FB, Dujovny M, et al. The perforating branches of the middle cerebral artery: a microanatomical study. J Neurosurg. 1985;62(2):261- 8. http://dx.doi.org/10.3171/jns.1985.62.2.0261. PMid:3968566.

3. Isolan GR, Pires de Aguiar PH, Aires R, Meister CS, Stefani MA. Middle cerebral artery “pseudotetrafurcation”anatomic report and review of middle cerebral artery variations. Neurosurg Q. 2010;20(4):284-7. http://dx.doi.org/10.1097/WNQ.0b013e3182012d98.

4. Kazumata K, Kamiyama H, Ishikawa T, et al. Operative anatomy and classification of the sylvian veins for the distal transsylvian approach. Neurol Med Chir. 2003;43(9):427-33. http://dx.doi.org/10.2176/ nmc.43.427. PMid:14560846.

5. Estevão I, Camporeze B, Araujo AS Jr, et al. Middle cerebral artery aneurysms: aneurysm angiographic morphology and its relation to pre-operative and intra-operative rupture. Arq Neuropsiquiatr. 2017;75(8):523- 32. http://dx.doi.org/10.1590/0004-282x20170082. PMid:28813082.

6. Garrett M, Spetzler R. Surgical treatment of blister like aneurysm. World Neurosurg. 2012;77(1):76-7. http://dx.doi.org/10.1016/j. wneu.2011.07.041. PMid:22405389.

7. Piske RL, Kanashiro LH, Paschoal E, Agner C, Lima SS, Aguiar PH. Evaluation of Onyx HD-500 embolic system in the treatment of 84 wide-neck intracranial aneurysms. Neurosurgery. 2009;64(5):e865-75. http://dx.doi.org/10.1227/01.NEU.0000340977.68347.51. PMid:19404128.

8. Connolly E Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/ american Stroke Association. Stroke. 2012;43(6):1711-37. http://dx.doi. org/10.1161/STR.0b013e3182587839. PMid:22556195.

9. Wen WT, Oliveira E, Tedeschi H, Andrade F Jr, Rothon AL Jr. The pterional approach: surgical anatomy, operative technique, and rationale. Oper Neurosurg. 2001;4(2):60-72. http://dx.doi.org/10.1053/ otns.2001.25567.

10. Pires de Aguiar PH, Santiago NM, Zicarelli CA, Aires R. Lenticulostriate brain aneurysms. Neurosurg Q. 2010;20(4):280-3. http://dx.doi.org/10.1097/WNQ.0b013e31820129a3.

11. Araújo AS Jr, Aguiar PH, Fazzito MM, et al. Prospective factors of temporary arterial occlusion during anterior communicating artery aneurysm repair. Acta Neurochir Suppl. 2015;120:231-5. http://dx.doi. org/10.1007/978-3-319-04981-6_39. PMid:25366629.

12. Aires R, Galafassi G, Pinho MCV, et al. Preoperative scale proposal based on clinical outcome for elderly patients with ruptured intracranial aneurysms undergoing microsurgery. Int J Neurosci. 2023;133(10):1204-10. http://dx.doi.org/10.1080/00207454.2022.2 070488. PMid:35465825.

13. Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med. 2006;355(9):928-39. http://dx.doi.org/10.1056/NEJMra052760. PMid:16943405.

14. Giacomelli Leal A, Ramina R, Pires de Aguiar PH, Feranandes BL, Souza MA, Nohama P. Clinical applications of additive manufacturing models in neurosurgery: a systematic review. Braz Neurosurg. 2021;40(4):e349-60. http://dx.doi.org/10.1055/s-0041-1740646.

15. Shibata E, Takao H, Amemiya S, Ohtomo K. 3D-printed visceral aneurysm models based on ct data for simulations of endovascular embolization: evaluation of size and shape accuracy. AJR Am J Roentgenol. 2017;209(2):243-7. http://dx.doi.org/10.2214/AJR.16.17694. PMid:28731812.



1MS, Medical student, Academic internship in Neurosurgery, Serviço de Neurocirurgia, Centro Universitário Faculdade de Medicina ABC, Santo André, SP, Brasil.

2MS, Medical student, Academic internship in Neurosurgery, Faculdade de Ciências Médicas e Saúde, Pontifícia Universidade Católica de Sorocaba, Sorocaba, SP, Brasil.

3MD, MR, Medical residency in Neurosurgery, Serviço de Neurocirurgia, Centro Universitário Faculdade de Medicina ABC, Santo André, SP, Brasil.

4MD, Adjunct Professor Neurology and Neurosurgery, Faculdade de Medicina ABC, Centro Universitário Faculdade de Medicina ABC, Santo André, SP, Brasil.

5MD, Supervisor of Neurosurgery Service, Hospital Municipal de Santo André, Faculdade de Medicina ABC, Centro Universitário Faculdade de Medicina ABC, Santo André, SP, Brasil.

 

Received Dec 23, 2023

Accepted Dec 30, 2023

JBNC  Brazilian Journal of Neurosurgery

  •   ISSN (print version): 0103-5118
  •   e-ISSN (online version): 2446-6786

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