Characteristics and management of ruptured distal middle cerebral artery aneurysms
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Objective. Distal middle cerebral artery (dMCA) aneurysms are very rare with a reported frequency of 2–6%. Typically, patients with ruptured distal MCA aneurysms have poor clinical outcomes because often there is both a subarachnoid haemorrhage (SAH) and an intracerebral haematoma (ICH). The goals of this study were to identify the characteristics of the distal MCA aneurysms and evaluate the optimal treatment for a good outcome.
Methods. The clinical, neuroradiological and operative records of 8 patients with a ruptured distal MCA aneurysm who underwent surgical management were reviewed retrospectively. The outcomes were presented according to the Glasgow Outcome Scale (GOS).
Results. The clinical characteristics of the patients with ruptured dMCA aneurysms included the following: (1) a fusiform appearance in five out of eight (63%) patients. (2) Mean aneurysm size of 9.4 mm (range 2–35 mm). (3) The location being M2 (insular segment) in three, M2-3 junction in three, and M3 (opercular segment) in two patients. (4) Brain CT images revealed both SAH and an ICH in six of eight (75%) patients with the mean size of the ICH being 10 cc (range 5–25 cc). (5) Re-bleeding occurred in four out of eight (50%) of patients. All patients underwent early surgical treatment and the procedures used for surgical repair were, clipping in five patients, trapping in two, and trapping with end-to-end bypass surgery in one patient. Clinical outcomes were poor in two patients (death) due to severe brain swelling.
Conclusions. In this study, dMCA aneurysms had a fusiform shape and a high re-bleeding rate; if ruptured, there was generally ICH and SAH. A good clinical outcome was associated with adequate control of brain swelling and early surgery to prevent re-bleeding.
- Brandt, L, Sonesson, B, Ljunggren, B, Saveland, H (1987) Ruptured middle cerebral artery aneurysm with intracerebral haemorrhage in younger patients appearing moribund: emergency operation?. Neurosurgery 20: pp. 925-929 CrossRef
- Chyatte, D, Porterfield, R (2001) Nuances of middle cerebral artery aneurysm microsurgery. Neurosurgery 48: pp. 339-346 CrossRef
- Damasio, H, Seabra-Gomes, R, da Silva, JP, Damasio, AR, Antunes, JL (1975) Multiple cerebral aneurysms and cardiac myxoma. Arch Neurol 32: pp. 269-270
- Gibo, H, Carver, CC, Rhoton, AL, Lenkey, C, Mitchell, RJ (1981) Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54: pp. 151-169 CrossRef
- Horiuchi, T, Tanaka, Y, Takasawa, H, Murata, T, Yako, T, Hongo, K (2004) Ruptured distal middle cerebral artery aneurysm. J Neurosurg 100: pp. 384-388 CrossRef
- Johnson, HR, South, JR (1980) Traumatic dissecting aneurysm of the middle cerebral artery. Surg Neurol 14: pp. 224-226
- Kyriacou, SK, Humphrey, JD (1996) Influence of size, shape and properties on the mechanics of axisymmetric saccular aneurysms. J Biomech 29: pp. 1015-1022 CrossRef
- Marchel, A (1987) Results of the surgical treatment of patients with single aneurysms of the middle cerebral artery. Neurol Neurochir Pol 21: pp. 534-540
- Ohashi, Y, Horikoshi, T, Sugita, M, Yagishita, T, Nukui, H (2004) Size of cerebral aneurysms and related factors in patients with subarachnoid haemorrhage. Surg Neurol 61: pp. 239-245 CrossRef
- Osawa, M, Hongo, K, Tanaka, Y, Nakamura, Y, Kitazawa, K, Kobayashi, S (2001) Results of direct surgery for aneurysmal subarachnoid haemorrhage: outcome of 2055 patients who underwent direct aneurysm surgery and profile of ruptured intracranial aneurysms. Acta Neurochir (Wien) 143: pp. 655-663 CrossRef
- Piepgras, DG, McGrail, KM, Tazelaar, HD (1994) Intracranial dissection of the distal middle cerebral artery as an uncommon cause of distal cerebral artery aneurysm. Case report. J Neurosurg 80: pp. 909-913 CrossRef
- Poppen, JL (1951) Specific treatment of intracranial aneurysms; experiences with 143 surgically treated patients. J Neurosurg 8: pp. 75-102 CrossRef
- Rinne, J, Hernesniemi, J, Niskanen, M, Vapalahti, M (1996) Analysis of 561 patients with 690 middle cerebral artery aneurysms: anatomic and clinical features as correlated to management outcome. Neurosurgery 38: pp. 2-11 CrossRef
- Russell, SM, Lin, K, Hahn, SA, Jafar, JJ (2003) Smaller cerebral aneurysms producing more extensive subarachnoid haemorrhage following rupture: a radiological investigation and discussion of theoretical determinants. J Neurosurg 99: pp. 248-253 CrossRef
- Sato, O, Bascom, JF, Logothetis, J (1971) Intracranial dissecting aneurysm. Case report. J Neurosurg 35: pp. 483-487 CrossRef
- Stoodley, MA, Macdonald, RL, Weir, BK (1998) Surgical treatment of middle cerebral artery aneurysms. Neurosurg Clin N Am 9: pp. 823-834
- Suzuki, J, Yoshimoto, T, Kayama, T (1984) Surgical treatment of middle cerebral artery aneurysms. No Shinkei Geka 12: pp. 289-296
- Yasargil, MG (1984) Microneurosurgery II. Georg Thieme Verlag, Stuttgart
- Characteristics and management of ruptured distal middle cerebral artery aneurysms
Volume 149, Issue 7 , pp 661-667
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Keywords: Subarachnoid haemorrhage; distal middle cerebral artery aneurysm; re-bleeding; intracerebral haematoma.
- Industry Sectors