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Updated: Jan 23, 2026
18:50
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
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Brain Bypass Surgery for Complex Middle Cerebral Artery Aneurysms: Evolving Techniques, Results, and Lessons Learned
Sabareesh K Natarajan1, Qazi Zeeshan2, Basavaraj V Ghodke3
1Department of Neurosurgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
World Neurosurgery
|June 18, 2019
Summary
Cerebral revascularization effectively treats middle cerebral artery (MCA) aneurysms, achieving high occlusion rates with patent bypasses. This technique offers a safe adjunct for complex MCA aneurysms, improving patient outcomes.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Cerebrovascular Surgery
Background:
- Middle cerebral artery (MCA) aneurysms often require complex treatment strategies.
- Achieving complete aneurysm occlusion while preserving flow through critical MCA branches can be challenging.
- Adjunctive cerebral revascularization is sometimes necessary for successful MCA aneurysm treatment.
Purpose of the Study:
- To analyze the safety and efficacy of cerebral revascularization as an adjunct procedure for treating middle cerebral artery (MCA) aneurysms.
- To evaluate the long-term patency of bypass grafts and the rates of aneurysm occlusion.
- To assess clinical outcomes and functional status following revascularization for MCA aneurysms.
Main Methods:
- A consecutive series of 42 patients with 43 MCA aneurysms underwent 52 bypass procedures over 13 years.
- Procedures included various intracranial and extracranial bypass techniques, such as STA-MCA anastomosis and radial artery grafts.
- Aneurysm locations ranged from the M1 trunk to M2 segments and beyond.
Main Results:
- 98% of bypasses remained patent at long-term follow-up, with complete occlusion of all 43 aneurysms.
- Six patients (14%) experienced treatment-related strokes.
- At follow-up, 73.8% of patients improved functionally (modified Rankin score 0-2).
Conclusions:
- Cerebral revascularization is a safe and effective adjunct for treating complex MCA aneurysms.
- The procedure facilitates complete aneurysm occlusion while maintaining essential cerebral blood flow.
- This study provides valuable insights from the learning curve associated with these advanced techniques.
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