Division of Interventional Neuroradiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles 90095-1721, California, USA.
Neurosurgery. 2009 Dec;65(6 Suppl):121-9; discussion 129-31. doi: 10.1227/01.NEU.0000335173.80605.1D.
Our goal was to assess the long-term anatomic and clinical outcomes in patients with giant middle cerebral artery (MCA) aneurysms treated by endovascular coil embolization alone or in combination with cerebral revascularization.
One hundred twenty-six patients with giant intracranial aneurysms were endovascularly treated at the University of California, Los Angeles, between 1990 and 2007. Of these, 9 patients had partially thrombosed MCA aneurysms with incorporated branches. Five patients presented with symptoms of mass effect, 3 had seizures, 2 had episodes of brain ischemia, and 1 presented with acute subarachnoid hemorrhage.
Three wide-neck saccular aneurysms were almost completely coil occluded, leaving only small neck remnants that were intended to preserve the patency of incorporated MCA branches. The other 6 fusiform aneurysms were effectively treated by superficial temporal artery-MCA or occipital artery-MCA bypass, followed by complete coil occlusion of these aneurysms. Immediate angiograms and mid- or long-term neuroradiological imaging follow-up examinations revealed complete obliteration or near-complete occlusion (90%-99%) of the aneurysms in all 9 patients. Seven patients had a favorable long-term clinical outcome, and 1 patient died as a result of unrelated congestive heart failure. One patient required emergent surgical aneurysm thrombectomy because of inadvertent coil occlusion of the frontal opercular artery, which was not protected by the bypass, and the patient subsequently sustained a moderate neurological disability.
Giant MCA aneurysms with branch incorporations and other unfavorable features such as intraluminal thrombus, mural calcification, and fusiform configuration can be effectively treated with a team approach, using coil embolization after protective surgical bypass. When aneurysms with MCA branches incorporated into the neck rather than the dome are treated by endovascular techniques alone, long-term angiographic follow-up is necessary to assess and further treat any significant remnant.
评估单独采用血管内线圈栓塞或联合脑血运重建治疗巨大大脑中动脉（MCA）动脉瘤患者的长期解剖学和临床结果。
1990 年至 2007 年，加利福尼亚大学洛杉矶分校共对 126 例颅内巨大动脉瘤患者进行了血管内治疗。其中 9 例患者 MCA 部分血栓形成伴分支受累。5 例患者有占位效应症状，3 例有癫痫发作，2 例有脑缺血发作，1 例有急性蛛网膜下腔出血。
3 例宽颈囊状动脉瘤几乎完全用线圈闭塞，仅留下小的颈部残端，以保持受累 MCA 分支的通畅。另外 6 例梭形动脉瘤通过颞浅动脉-MCA 或枕动脉-MCA 旁路有效治疗，然后完全用线圈闭塞这些动脉瘤。即刻血管造影和中期或长期神经影像学随访检查显示，9 例患者的动脉瘤完全闭塞或近完全闭塞（90%-99%）。7 例患者有良好的长期临床结果，1 例患者因无关的充血性心力衰竭死亡。1 例患者因无意中闭塞旁路未保护的额盖动脉线圈而需要紧急手术动脉瘤血栓切除术，患者随后出现中度神经功能障碍。
对于合并分支受累的巨大 MCA 动脉瘤和其他不利特征，如管腔内血栓形成、壁钙化和梭形形态，可以采用团队治疗方法，在保护外科旁路后进行线圈栓塞。当颈内而非瘤顶受累的 MCA 分支动脉瘤采用单纯血管内技术治疗时，需要长期血管造影随访来评估和进一步治疗任何明显的残余病变。
