Skip to main content
SpringerLink
Log in

Endovascular treatment for saccular aneurysms of the proximal (M1) segment of the middle cerebral artery

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Saccular aneurysms located at the M1 segment of the middle cerebral artery (MCA) are uncommon, and endovascular treatment (EVT) for them is not well documented. We performed this study to evaluate the feasibility, safety, and efficacy of EVT for proximal (M1) segment saccular aneurysm of the middle cerebral artery.

Methods

Of 153 MCA aneurysms between January 2007 and September 2011, 29 patients with 29 M1 segment saccular aneurysms were treated at our institution via endovascular approach. There were 14 men and 15 women with a mean age of 56.2 years (range 36–78 years).

Results

Treatments were successful in 28 (96.6 %) cases, including coiling alone in 19 patients, stent-assisted coiling in 8, and balloon-assisted coiling in 1. In the failed case, coiling was not successful, and only a stent was deployed. Immediate angiograms showed total occlusion in 13 patients, neck remnant in 7, partial occlusion in 8, and contrast stasis in the patient who was not coiled successfully. Two (6.9 %) procedure-related complications occurred, including early temporal branch (ETB) obliteration in one patient and lenticulostriate artery (LSA) occlusion in the other one, which resulted in hemiparalysis of one patient. Three patients died from initial severe SAH during hospitalization. One patient died from heart infarction 1 month after operation. Twenty-three of 25 surviving patients underwent follow-up cerebral angiography at intervals ranging from 1 to 21 months (mean, 7.3 months). The result showed 14/23 (60.9 %) aneurysms were completely occluded, 3/23 (13 %) were recanalized, and others were stable or improved. The clinical follow-up (mean, 22.5 months) of all survived patients demonstrated no neurologic deterioration or rebleeding.

Conclusion

Our preliminary experience demonstrates that EVT for proximal MCA aneurysm is feasible and safe. However, more adequate follow-up is required to evaluate its long-term results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bracard S, Abdel-Kerim A, Thuillier L, Klein O, Anxionnat R, Finitsis S, Lebedinsky A, de Freitas CM, Pinheiro N, de Andrade GC, Picard L (2010) Endovascular coil occlusion of 152 middle cerebral artery aneurysms: initial and midterm angiographic and clinical results. J Neurosurg 112:703–708

    Article  PubMed  Google Scholar 

  2. Brinjikji W, Lanzino G, Cloft HJ, Rabinstein A, Kallmes DF (2011) Endovascular treatment of middle cerebral artery aneurysms: a systematic review and single-center series. Neurosurgery 68:397–402, discussion 402

    Article  PubMed  Google Scholar 

  3. Dai D, Ding YH, Kadirvel R, Rad AE, Lewis DA, Kallmes DF (2012) Patency of branches after coverage with multiple telescoping flow-diverter devices: an in vivo study in rabbits. AJNR Am J Neuroradiol 33:171–174

    Article  PubMed  CAS  Google Scholar 

  4. Deutschmann HA, Wehrschuetz M, Augustin M, Niederkorn K, Klein GE (2012) Long-term follow-up after treatment of intracranial aneurysms with the Pipeline embolization device: results from a single center. AJNR Am J Neuroradiol 33:481–486

    Article  PubMed  CAS  Google Scholar 

  5. Doerfler A, Wanke I, Goericke SL, Wiedemayer H, Engelhorn T, Gizewski ER, Stolke D, Forsting M (2006) Endovascular treatment of middle cerebral artery aneurysms with electrolytically detachable coils. AJNR Am J Neuroradiol 27:513–520

    PubMed  CAS  Google Scholar 

  6. Fields JD, Brambrink L, Dogan A, Helseth EK, Liu KC, Lee DS, Nesbit GM, Petersen BD, Barnwell SL (2011) Stent assisted coil embolization of unruptured middle cerebral artery aneurysms. J Neurointerv Surg. doi:10.1136/neurintsurg-2011-010162

  7. Ha SK, Lim DJ, Kang SH, Kim SH, Park JY, Chung YG (2011) Analysis of multiple factors affecting surgical outcomes of proximal middle cerebral artery aneurysms. Clin Neurol Neurosurg 113:362–367

    Article  PubMed  Google Scholar 

  8. Hosoda K, Fujita S, Kawaguchi T, Shose Y, Hamano S (1995) Saccular aneurysms of the proximal (M1) segment of the middle cerebral artery. Neurosurgery 36:441–446

    Article  PubMed  CAS  Google Scholar 

  9. Iwama T, Yoshimura S, Kaku Y, Sakai N (2004) Considerations in the surgical treatment of superior-wall type aneurysm at the proximal (M1) segment of the middle cerebral artery. Acta Neurochir (Wien) 146:967–972, discussion 972

    Article  CAS  Google Scholar 

  10. Kim BM, Kim DI, Park SI, Kim DJ, Suh SH, Won YS (2011) Coil embolization of unruptured middle cerebral artery aneurysms. Neurosurgery 68:346–353, discussion 353–354

    Article  PubMed  Google Scholar 

  11. Park DH, Kang SH, Lee JB, Lim DJ, Kwon TH, Chung YG, Lee HK (2008) Angiographic features, surgical management and outcomes of proximal middle cerebral artery aneurysms. Clin Neurol Neurosurg 110:544–551

    Article  PubMed  Google Scholar 

  12. Paulo MS, Edgardo S, Fernando M, Pablo P, Alejandro T, Veronica V (2010) Aneurysms of the middle cerebral artery proximal segment (M1). Anatomical and therapeutic considerations. Revision of a series. Analysis of a series of the pre bifurcation segment aneurysms. Asian J Neurosurg 5:57–63

    PubMed  Google Scholar 

  13. Pero G, Denegri F, Valvassori L, Boccardi E, Scialfa G (2006) Treatment of a middle cerebral artery giant aneurysm using a covered stent. Case report. J Neurosurg 104:965–968

    Article  PubMed  Google Scholar 

  14. 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 38:2–11

    Article  PubMed  CAS  Google Scholar 

  15. Suzuki S, Tateshima S, Jahan R, Duckwiler GR, Murayama Y, Gonzalez NR, Vinuela F (2009) Endovascular treatment of middle cerebral artery aneurysms with detachable coils: angiographic and clinical outcomes in 115 consecutive patients. Neurosurgery 64:876–888, discussion 888–889

    Article  PubMed  Google Scholar 

  16. Tanriover N, Kawashima M, Rhoton AL Jr, Ulm AJ, Mericle RA (2003) Microsurgical anatomy of the early branches of the middle cerebral artery: morphometric analysis and classification with angiographic correlation. J Neurosurg 98:1277–1290

    Article  PubMed  Google Scholar 

  17. Ulm AJ, Fautheree GL, Tanriover N, Russo A, Albanese E, Rhoton AL Jr, Mericle RA, Lewis SB (2008) Microsurgical and angiographic anatomy of middle cerebral artery aneurysms: prevalence and significance of early branch aneurysms. Neurosurgery 62:ONS344–ONS352, discussion ONS352–353

    Article  PubMed  Google Scholar 

  18. Vendrell JF, Costalat V, Brunel H, Riquelme C, Bonafe A (2011) Stent-assisted coiling of complex middle cerebral artery aneurysms: initial and midterm results. AJNR Am J Neuroradiol 32:259–263

    Article  PubMed  Google Scholar 

  19. Vendrell JF, Menjot N, Costalat V, Hoa D, Moritz J, Brunel H, Bonafe A (2009) Endovascular treatment of 174 middle cerebral artery aneurysms: clinical outcome and radiologic results at long-term follow-up. Radiology 253:191–198

    Article  PubMed  Google Scholar 

  20. Yang P, Liu J, Huang Q, Zhao W, Hong B, Xu Y, Zhao R (2010) Endovascular treatment of wide-neck middle cerebral artery aneurysms with stents: a review of 16 cases. AJNR Am J Neuroradiol 31:940–946

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This work was supported by the National Natural Science Foundation of China (81000494), the Dawn Project of Shanghai (11CG043), and the Science and Technology Commission of Shanghai Municipality (10441901902)

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, Peoples Republic of China

    Yu Zhou, Peng-Fei Yang, Yi-Bin Fang, Yi Xu, Bo Hong, Wen-Yuan Zhao, Qiang Li, Rui Zhao, Qing-Hai Huang & Jian-Min Liu

Authors
  1. Yu Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peng-Fei Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yi-Bin Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yi Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bo Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wen-Yuan Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Qiang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rui Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Qing-Hai Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jian-Min Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jian-Min Liu.

Additional information

Yu Zhou and Peng-Fei Yang contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhou, Y., Yang, PF., Fang, YB. et al. Endovascular treatment for saccular aneurysms of the proximal (M1) segment of the middle cerebral artery. Acta Neurochir 154, 1835–1843 (2012). https://doi.org/10.1007/s00701-012-1453-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-012-1453-7

Keywords

Search

Navigation