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Updated: May 29, 2025
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
A Case of Flow Diverter Placement for a Recurrent Large Thrombosed Middle Cerebral Artery Aneurysm
Yusuke Tanaka1, Masato Tsuchimochi1, Raisa Funatsuya1
1Department of Neurosurgery, Yokohama Medical Center, Yokohama, Kanagawa, Japan.
Objective:
There are only a few reports about flow diverter (FD) placement for large thrombosed aneurysms of the middle cerebral artery (MCA). We present a case of FD placement for a recurrent large thrombosed aneurysm of MCA at our hospital.
Case Presentation:
A 72-year-old man with transient visual field disturbance underwent craniotomy for a large aneurysm in the left MCA; dome clipping was performed because of severe arteriosclerosis. Over several years, the residual aneurysm gradually increased in size, and despite antiplatelet therapy, the patient experienced repeated cerebral infarctions due to intra-aneurysmal thrombosis. A closer examination revealed that the M2 superior trunk was occluded. Thus, we performed FD placement, without further complications. After 6 months, the aneurysm was confirmed to be occluded with an O'Kelly-Marotta grading scale (OKM grade) of D. There was no enlargement of the thrombus inside the aneurysm, and the patient is currently under follow-up observation.
Conclusion:
FD placement may be an option for large thrombosed aneurysms of MCA that are difficult to treat with conventional methods.
Insights
Flow diverter (FD) placement is a viable treatment for large, recurrent middle cerebral artery (MCA) aneurysms with thrombosis. This case demonstrates successful FD use in a complex MCA aneurysm previously treated with clipping.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Large thrombosed aneurysms of the middle cerebral artery (MCA) present significant treatment challenges.
- Conventional treatments may be insufficient for complex or recurrent MCA aneurysms.
- Intra-aneurysmal thrombosis can lead to recurrent ischemic events.
