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The combined treatment of stenting and surgery in a giant unruptured aneurysm of the middle cerebral artery.

Skrap M, Petralia B, Toniato G - Surg Neurol Int (2015)

Bottom Line: A 51-year-old male presented with a sudden onset of moderate left hemiparesis and dysarthria.Two weeks later, the patient underwent the positioning of an Enterprise stent and inside this, a flow diverter Silk stent.The combined placement of the stents allowed safe and successful surgical dissection of the M2 branches and clipping of the aneurysm without interrupting the blood flow.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Udine University-Hospital P. le S. Maria della Misericordia 15, 33100, Udine, Italy.

ABSTRACT

Background: This case study reports on a combined therapy of stenting and surgery for a giant unruptured middle cerebral artery (MCA) aneurysm with the aim of preserving the patency of the vessel during surgery.

Case description: A 51-year-old male presented with a sudden onset of moderate left hemiparesis and dysarthria. Neuro-radiological evaluations showed a giant right unruptured MCA aneurysm without subarachnoid hemorrhage (SAH). The cerebral angiography confirmed the presence of such an aneurysm producing compression of both M2 branches with consequent slowing of the blood flow. Two weeks later, the patient underwent the positioning of an Enterprise stent and inside this, a flow diverter Silk stent. They were placed across the aneurysm and in one of the two M2 branches with the aim of protecting them during surgical manipulation. The patient went immediately to surgery, where the aneurysm was resected and both M2 branches decompressed.

Conclusion: The combined placement of the stents allowed safe and successful surgical dissection of the M2 branches and clipping of the aneurysm without interrupting the blood flow.

No MeSH data available.


Related in: MedlinePlus

(a,b,c) The CT and CTA carried out at admission showed a right giant unruptured MCA aneurysm
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Figure 1: (a,b,c) The CT and CTA carried out at admission showed a right giant unruptured MCA aneurysm

Mentions: A 51-year-old male was hospitalized in our department following sudden onset of a left hemiparesis. The cerebral computed tomography (CT) and the computed tomographic angiogram (CTA) scans, carried out at admission, showed a right giant MCA aneurysm without subarachnoid hemorrhage (SAH) but with mass effect [Figure 1]. The baseline cerebral angiography confirmed the presence of a giant aneurysm (about 20 × 30 mm with the largest perpendicular diameters in the anteroposterior projection) at the MCA bifurcation. The vascular flow through the MCA was very slow and its contrast opacification was delayed with respect to the ipsilateral anterior cerebral artery (ACA) by 1.75 s [Figure 2]. No embolic occlusions were seen. Angiographic images of the left carotid artery and vertebro-basilar complex were normal. At admission, an antiedema therapy with dexamethason was administered, which favoured the almost complete recovery of the symptoms within a few days.


The combined treatment of stenting and surgery in a giant unruptured aneurysm of the middle cerebral artery.

Skrap M, Petralia B, Toniato G - Surg Neurol Int (2015)

(a,b,c) The CT and CTA carried out at admission showed a right giant unruptured MCA aneurysm
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4418101&req=5

Figure 1: (a,b,c) The CT and CTA carried out at admission showed a right giant unruptured MCA aneurysm
Mentions: A 51-year-old male was hospitalized in our department following sudden onset of a left hemiparesis. The cerebral computed tomography (CT) and the computed tomographic angiogram (CTA) scans, carried out at admission, showed a right giant MCA aneurysm without subarachnoid hemorrhage (SAH) but with mass effect [Figure 1]. The baseline cerebral angiography confirmed the presence of a giant aneurysm (about 20 × 30 mm with the largest perpendicular diameters in the anteroposterior projection) at the MCA bifurcation. The vascular flow through the MCA was very slow and its contrast opacification was delayed with respect to the ipsilateral anterior cerebral artery (ACA) by 1.75 s [Figure 2]. No embolic occlusions were seen. Angiographic images of the left carotid artery and vertebro-basilar complex were normal. At admission, an antiedema therapy with dexamethason was administered, which favoured the almost complete recovery of the symptoms within a few days.

Bottom Line: A 51-year-old male presented with a sudden onset of moderate left hemiparesis and dysarthria.Two weeks later, the patient underwent the positioning of an Enterprise stent and inside this, a flow diverter Silk stent.The combined placement of the stents allowed safe and successful surgical dissection of the M2 branches and clipping of the aneurysm without interrupting the blood flow.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Udine University-Hospital P. le S. Maria della Misericordia 15, 33100, Udine, Italy.

ABSTRACT

Background: This case study reports on a combined therapy of stenting and surgery for a giant unruptured middle cerebral artery (MCA) aneurysm with the aim of preserving the patency of the vessel during surgery.

Case description: A 51-year-old male presented with a sudden onset of moderate left hemiparesis and dysarthria. Neuro-radiological evaluations showed a giant right unruptured MCA aneurysm without subarachnoid hemorrhage (SAH). The cerebral angiography confirmed the presence of such an aneurysm producing compression of both M2 branches with consequent slowing of the blood flow. Two weeks later, the patient underwent the positioning of an Enterprise stent and inside this, a flow diverter Silk stent. They were placed across the aneurysm and in one of the two M2 branches with the aim of protecting them during surgical manipulation. The patient went immediately to surgery, where the aneurysm was resected and both M2 branches decompressed.

Conclusion: The combined placement of the stents allowed safe and successful surgical dissection of the M2 branches and clipping of the aneurysm without interrupting the blood flow.

No MeSH data available.


Related in: MedlinePlus