Dome Resection and End-to-End Reanastomosis for a Middle Cerebral Artery Fusiform Aneurysm of the M1 Segment: 2-Dimensional Operative Video

Authors

Muhammad Kusdiansah, Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan; Department of Neurosurgery, National Brain Center Hospital, Prof. Dr. dr. Mahar Madjono, Jakarta, Indonesia.
Arnau Benet, Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Yosuke Suzuki, Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
Nakao Ota, Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
Kosumo Noda, Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
Rokuya Tanikawa, Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan. Electronic address: superbypass@gmail.com.

Document Type

Article

Abstract

Fusiform aneurysms of the middle cerebral artery (MCA) are both relatively uncommon and challenging to treat given their pathophysiology, morphology, and anatomy (e.g., perforating arteries involvement). Endovascular treatment of fusiform MCA aneurysms can achieve good outcomes in well-selected cases. Open microsurgical strategies are effective in a case of fusiform MCA aneurysms with complex anatomy or perforator involvement. We demonstrate the bypass strategy for resection of a fusiform M1 MCA aneurysm (Video 1). A 48-year-old female was referred for the treatment of a growing incidental right M1 MCA fusiform aneurysm. Imaging showed a tortuous M1 segment with no apparent perforator involvement, which we considered a candidate for resection and reanastomosis. A modified minipterional transsylvian approach was performed as described earlier. A double superficial temporal artery to middle cerebral artery bypass was performed to maintain flow to MCA territory and distal perforators in anticipation of a long temporary flow arrest due to complex aneurysmal dissection and reanastomosis and also to serve as long-term protective insurance. Resection and end-to-end reanastomosis will preserve the antegrade flow and prevent the risk stump thrombosis carried by a simple trapping. We cover the nuances of this technique including key steps to an efficient aneurysmal resection and complication avoidance. The patient tolerated the procedure well, and postoperative imaging showed no aneurysmal remnant and flow restoration with no evidence of stroke. We discharged the patient home with a modified Rankin scale of 0. The patient consented to the procedure and publication of his or her image.

Medical Subject Headings

Humans; Male; Female; Middle Aged; Middle Cerebral Artery (diagnostic imaging, surgery); Intracranial Aneurysm (diagnostic imaging, surgery, complications); Temporal Arteries (surgery); Neurosurgical Procedures (methods); Surgical Instruments; Cerebral Revascularization (methods)

Publication Date

10-1-2023

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

178

First Page

114

PubMed ID

37473862

Digital Object Identifier (DOI)

10.1016/j.wneu.2023.07.047

Recommended Citation

Kusdiansah, Muhammad; Benet, Arnau; Suzuki, Yosuke; Ota, Nakao; Noda, Kosumo; and Tanikawa, Rokuya, "Dome Resection and End-to-End Reanastomosis for a Middle Cerebral Artery Fusiform Aneurysm of the M1 Segment: 2-Dimensional Operative Video" (2023). Neurosurgery. 2123.
https://scholar.barrowneuro.org/neurosurgery/2123