Management of giant middle cerebral artery aneurysms with incorporated branches: Partial endovascular coiling or combined extracranial- intracranial bypass-a team approach

Zhong Song Shi, Jordan Ziegler, Gary R. Duckwiler, Reza Jahan, John Frazee, James I. Ausman, Neil A. Martin, Fernando Viñuela

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

OBJECTIVE: Our goal was to assess the long-term anatomic and clinical outcomes in patients with giant middle cerebral artery (MCA) aneurysms treated by endovascular coil embolization alone or in combination with cerebral revascularization. METHODS: One hundred twenty-six patients with giant intracranial aneurysms were endovascularly treated at the University of California, Los Angeles, between 1990 and 2007. Of these, 9 patients had partially thrombosed MCA aneurysms with incorporated branches. Five patients presented with symptoms of mass effect, 3 had seizures, 2 had episodes of brain ischemia, and 1 presented with acute subarachnoid hemorrhage. RESULTS: Three wide-neck saccular aneurysms were almost completely coil occluded, leaving only small neck remnants that were intended to preserve the patency of incorporated MCA branches. The other 6 fusiform aneurysms were effectively treated by superficial temporal artery-MCA or occipital artery-MCA bypass, followed by complete coil occlusion of these aneurysms. Immediate angiograms and mid- or long-term neuroradiological imaging follow-up examinations revealed complete obliteration or near-complete occlusion (90%-99%) of the aneurysms in all 9 patients. Seven patients had a favorable long-term clinical outcome, and 1 patient died as a result of unrelated congestive heart failure. One patient required emergent surgical aneurysm thrombectomy because of inadvertent coil occlusion of the frontal opercular artery, which was not protected by the bypass, and the patient subsequently sustained a moderate neurological disability. CONCLUSION: Giant MCA aneurysms with branch incorporations and other unfavorable features such as intraluminal thrombus, mural calcification, and fusiform configuration can be effectively treated with a team approach, using coil embolization after protective surgical bypass. When aneurysms with MCA branches incorporated into the neck rather than the dome are treated by endovascular techniques alone, long-term angiographic follow-up is necessary to assess and further treat any significant remnant.

Original languageEnglish (US)
JournalNeurosurgery
Volume65
Issue number6 SUPPL. 1
DOIs
StatePublished - Dec 1 2009
Externally publishedYes

Fingerprint

Intracranial Aneurysm
Aneurysm
Middle Cerebral Artery
Neck
Thrombosis
Arteries
Cerebral Revascularization
Temporal Arteries
Thrombectomy
Endovascular Procedures
Los Angeles
Subarachnoid Hemorrhage
Brain Ischemia
Angiography
Seizures
Heart Failure

Keywords

  • Cerebral revascularization
  • Coiling embolization
  • Endovascular treatment
  • Giant intracranial aneurysm
  • Middle cerebral artery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Management of giant middle cerebral artery aneurysms with incorporated branches : Partial endovascular coiling or combined extracranial- intracranial bypass-a team approach. / Shi, Zhong Song; Ziegler, Jordan; Duckwiler, Gary R.; Jahan, Reza; Frazee, John; Ausman, James I.; Martin, Neil A.; Viñuela, Fernando.

In: Neurosurgery, Vol. 65, No. 6 SUPPL. 1, 01.12.2009.

Research output: Contribution to journalArticle

Shi, Zhong Song ; Ziegler, Jordan ; Duckwiler, Gary R. ; Jahan, Reza ; Frazee, John ; Ausman, James I. ; Martin, Neil A. ; Viñuela, Fernando. / Management of giant middle cerebral artery aneurysms with incorporated branches : Partial endovascular coiling or combined extracranial- intracranial bypass-a team approach. In: Neurosurgery. 2009 ; Vol. 65, No. 6 SUPPL. 1.
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abstract = "OBJECTIVE: Our goal was to assess the long-term anatomic and clinical outcomes in patients with giant middle cerebral artery (MCA) aneurysms treated by endovascular coil embolization alone or in combination with cerebral revascularization. METHODS: One hundred twenty-six patients with giant intracranial aneurysms were endovascularly treated at the University of California, Los Angeles, between 1990 and 2007. Of these, 9 patients had partially thrombosed MCA aneurysms with incorporated branches. Five patients presented with symptoms of mass effect, 3 had seizures, 2 had episodes of brain ischemia, and 1 presented with acute subarachnoid hemorrhage. RESULTS: Three wide-neck saccular aneurysms were almost completely coil occluded, leaving only small neck remnants that were intended to preserve the patency of incorporated MCA branches. The other 6 fusiform aneurysms were effectively treated by superficial temporal artery-MCA or occipital artery-MCA bypass, followed by complete coil occlusion of these aneurysms. Immediate angiograms and mid- or long-term neuroradiological imaging follow-up examinations revealed complete obliteration or near-complete occlusion (90{\%}-99{\%}) of the aneurysms in all 9 patients. Seven patients had a favorable long-term clinical outcome, and 1 patient died as a result of unrelated congestive heart failure. One patient required emergent surgical aneurysm thrombectomy because of inadvertent coil occlusion of the frontal opercular artery, which was not protected by the bypass, and the patient subsequently sustained a moderate neurological disability. CONCLUSION: Giant MCA aneurysms with branch incorporations and other unfavorable features such as intraluminal thrombus, mural calcification, and fusiform configuration can be effectively treated with a team approach, using coil embolization after protective surgical bypass. When aneurysms with MCA branches incorporated into the neck rather than the dome are treated by endovascular techniques alone, long-term angiographic follow-up is necessary to assess and further treat any significant remnant.",
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T1 - Management of giant middle cerebral artery aneurysms with incorporated branches

T2 - Partial endovascular coiling or combined extracranial- intracranial bypass-a team approach

AU - Shi, Zhong Song

AU - Ziegler, Jordan

AU - Duckwiler, Gary R.

AU - Jahan, Reza

AU - Frazee, John

AU - Ausman, James I.

AU - Martin, Neil A.

AU - Viñuela, Fernando

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N2 - OBJECTIVE: Our goal was to assess the long-term anatomic and clinical outcomes in patients with giant middle cerebral artery (MCA) aneurysms treated by endovascular coil embolization alone or in combination with cerebral revascularization. METHODS: One hundred twenty-six patients with giant intracranial aneurysms were endovascularly treated at the University of California, Los Angeles, between 1990 and 2007. Of these, 9 patients had partially thrombosed MCA aneurysms with incorporated branches. Five patients presented with symptoms of mass effect, 3 had seizures, 2 had episodes of brain ischemia, and 1 presented with acute subarachnoid hemorrhage. RESULTS: Three wide-neck saccular aneurysms were almost completely coil occluded, leaving only small neck remnants that were intended to preserve the patency of incorporated MCA branches. The other 6 fusiform aneurysms were effectively treated by superficial temporal artery-MCA or occipital artery-MCA bypass, followed by complete coil occlusion of these aneurysms. Immediate angiograms and mid- or long-term neuroradiological imaging follow-up examinations revealed complete obliteration or near-complete occlusion (90%-99%) of the aneurysms in all 9 patients. Seven patients had a favorable long-term clinical outcome, and 1 patient died as a result of unrelated congestive heart failure. One patient required emergent surgical aneurysm thrombectomy because of inadvertent coil occlusion of the frontal opercular artery, which was not protected by the bypass, and the patient subsequently sustained a moderate neurological disability. CONCLUSION: Giant MCA aneurysms with branch incorporations and other unfavorable features such as intraluminal thrombus, mural calcification, and fusiform configuration can be effectively treated with a team approach, using coil embolization after protective surgical bypass. When aneurysms with MCA branches incorporated into the neck rather than the dome are treated by endovascular techniques alone, long-term angiographic follow-up is necessary to assess and further treat any significant remnant.

AB - OBJECTIVE: Our goal was to assess the long-term anatomic and clinical outcomes in patients with giant middle cerebral artery (MCA) aneurysms treated by endovascular coil embolization alone or in combination with cerebral revascularization. METHODS: One hundred twenty-six patients with giant intracranial aneurysms were endovascularly treated at the University of California, Los Angeles, between 1990 and 2007. Of these, 9 patients had partially thrombosed MCA aneurysms with incorporated branches. Five patients presented with symptoms of mass effect, 3 had seizures, 2 had episodes of brain ischemia, and 1 presented with acute subarachnoid hemorrhage. RESULTS: Three wide-neck saccular aneurysms were almost completely coil occluded, leaving only small neck remnants that were intended to preserve the patency of incorporated MCA branches. The other 6 fusiform aneurysms were effectively treated by superficial temporal artery-MCA or occipital artery-MCA bypass, followed by complete coil occlusion of these aneurysms. Immediate angiograms and mid- or long-term neuroradiological imaging follow-up examinations revealed complete obliteration or near-complete occlusion (90%-99%) of the aneurysms in all 9 patients. Seven patients had a favorable long-term clinical outcome, and 1 patient died as a result of unrelated congestive heart failure. One patient required emergent surgical aneurysm thrombectomy because of inadvertent coil occlusion of the frontal opercular artery, which was not protected by the bypass, and the patient subsequently sustained a moderate neurological disability. CONCLUSION: Giant MCA aneurysms with branch incorporations and other unfavorable features such as intraluminal thrombus, mural calcification, and fusiform configuration can be effectively treated with a team approach, using coil embolization after protective surgical bypass. When aneurysms with MCA branches incorporated into the neck rather than the dome are treated by endovascular techniques alone, long-term angiographic follow-up is necessary to assess and further treat any significant remnant.

KW - Cerebral revascularization

KW - Coiling embolization

KW - Endovascular treatment

KW - Giant intracranial aneurysm

KW - Middle cerebral artery

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