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Updated: Aug 14, 2026
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Ruptured cerebral aneurysms operated on with only MRA. Reports of two cases
G Parenti1, L Fiori, R Gasparotti
1Institute of Neurosurgery, University of Pisa, Italy.
Abstract:
Two cases of ruptured aneurysms of anterior communicating artery were reported. The aneuryms were showed only by means of MR angiography and operated on without conventional angiography, since patients' allergy to drugs and medium contrast. The MRA showed precisely the sites of the aneurysm and the directions of the sac, but underestimated the size of the sac. In spite of the lack of angiograms induced a great caution during the dissection of the aneurysm and made necessary a larger operative field, anyway clipping of the aneurysm's neck was performed without great difficulties.
Insights
This study reports two cases of ruptured anterior communicating artery aneurysms successfully clipped using only MR angiography. Despite underestimating sac size, MRA guided precise surgical intervention, avoiding conventional angiography due to patient allergies.
Area of Science:
- Neurosurgery
- Neuroradiology
- Vascular Neurology
Background:
- Ruptured anterior communicating artery aneurysms pose significant surgical challenges.
- Conventional angiography is standard for pre-operative planning but carries risks (e.g., contrast allergy).
- Magnetic Resonance Angiography (MRA) offers a non-invasive imaging alternative.
Observation:
- Two patients with ruptured anterior communicating artery aneurysms were evaluated solely with MRA.
- Patients had contraindications for conventional angiography, including drug and contrast medium allergies.
- MRA accurately identified aneurysm location and sac orientation.
Findings:
- MRA underestimated the true size of the aneurysmal sac in both cases.
- Surgical intervention required increased caution and a wider operative field due to imaging limitations.
- Successful aneurysm neck clipping was achieved without major complications.
Implications:
- MRA can be a viable primary diagnostic tool for anterior communicating artery aneurysms in select patients.
- Careful surgical technique is crucial when relying on MRA due to potential size underestimation.
- This approach may expand treatment options for patients with contrast allergies.
