Related Experiment Video
Updated: Jun 23, 2025
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
[Venous cerebral complications after microsurgery for complex aneurysms of the middle cerebral arteries]
Yu V Pilipenko1, Sh Sh Eliava1, O B Belousova1
1Burdenko Neurosurgical Center, Moscow, Russia.
Abstract:
Microsurgeries are common for complex aneurysms of the middle cerebral artery (MCA).
Objective:
To evaluate the incidence and types of venous cerebral disorders after microsurgeries for complex MCA aneurysms.
Material And Methods:
A retrospective study included 285 patients with complex MCA aneurysms between 2009 and 2020. Pterional craniotomy and transsylvian approach were used in all cases. Aneurysm clipping was performed in 230 cases, revascularization - 27, trapping without bypass - 17, reinforcement - in 11 cases. Computed tomography within 1-3 days after surgery recognized venous cerebral disorders as heterogeneous foci of abnormal brain density with unclear boundaries. These foci were crescent-shaped as a rule and located in deep and basal parts of the frontal lobes.
Results:
Venous abnormalities occurred in 76 (26.7%) patients. Thirty-five (12.3%) patients had mild venous edema of the frontal lobe alone. In 35 (12.3%) patients, we found moderate disorders with focus in the frontal lobe and compression of anterior horn of the left lateral ventricle with or without hemorrhagic imbibition. Severe disorders occurred in 6 (2.1%) patients with lesion extending to the frontal, insular and temporal lobes. These lesions were accompanied by hemorrhagic imbibition, and lateral dislocation exceeded 5 mm.
Conclusion:
Careful dissection of veins in Sylvian fissure with preservation of bridging veins is likely to reduce the risk of this complication. Cauterization of a large vein in Sylvian fissure should be followed by careful hemostasis within frontal or temporal cortex. Bleeding and cortical tension can indicate intracerebral hematoma whose likelihood is higher in patients with venous cerebral disorders.
Insights
Microsurgeries for middle cerebral artery (MCA) aneurysms can cause venous cerebral disorders in 26.7% of patients. Careful surgical technique, including vein preservation, may reduce the risk of these complications.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Neuroradiology
Context:
- Microsurgeries are frequently performed for complex middle cerebral artery (MCA) aneurysms.
- Venous cerebral disorders represent a potential complication following these procedures.
Purpose:
- To determine the incidence and types of venous cerebral disorders after microsurgery for complex MCA aneurysms.
- To analyze the characteristics and severity of these post-surgical venous abnormalities.
Summary:
- A retrospective study of 285 patients undergoing microsurgery for complex MCA aneurysms revealed venous abnormalities in 26.7%.
- Disorders ranged from mild frontal lobe edema to severe lesions affecting multiple brain regions, with some cases involving hemorrhagic imbibition and ventricular displacement.
- Computed tomography identified these as heterogeneous, often crescent-shaped foci of abnormal brain density.
Impact:
- Findings highlight the importance of meticulous surgical technique, particularly vein preservation in the Sylvian fissure, to minimize venous complications.
- Early recognition and management of bleeding or cortical tension are crucial, as they may indicate intracerebral hematoma in patients with venous cerebral disorders.
Related Concept Videos
01:26Arteries of the Head and Neck
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
01:10The Arch of Aorta
Encircling the heart, the coronary arteries form a ring-like structure before...