Cheng Chun-Yu, Qazi Zeeshan, Sekhar Laligam N
Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Oper Neurosurg. 2019 Oct 1;17(4):E159-E160. doi: 10.1093/ons/opy406.
This 16-yr-old boy presented with episodes of severe headaches, blurred vision, dizziness, and muffled hearing and was discovered to have a large fusiform aneurysm of the left middle cerebral artery (MCA), M1 segment, 20 × 12 mm in dimension. The lenticulostriate arteries were arising proximal and distal to the aneurysm, but the anterior temporal artery was arising from the aneurysm. The aneurysm culminated in the distal M1 segment, and M1 immediately branched into 3 M2 vessels, the lower one being the larger. Due to origin of the lenticulostriate arteries and the anterior temporal artery and patient's age, a bypass was preferred to a flow diversion stent. He underwent left frontotemporal craniotomy and orbital osteotomy, left cervical external carotid artery exposure followed by radial artery graft extraction. The Sylvian fissure was opened and intracranial ICA was exposed for proximal control. The distal M2 vessels traced back toward the aneurysm. The aneurysm was not clippable and a bypass to the larger inferior M2 branch was performed followed by aneurysm trapping. The radial artery graft bypass was placed from the left external carotid artery to the M2 segment of left MCA, followed by clip reconstruction and occlusion of the MCA aneurysm with the preservation of the anterior temporal branch and the lenticulostriate vessels. The patient had no postoperative complications. At the follow-up, one month after surgery, he was doing well, and his angiogram demonstrated patency of the bypass. This video shows the management of a complex fusiform M1 aneurysm with bypass and trapping. Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.
这名16岁男孩出现严重头痛、视力模糊、头晕和听力减退等症状，经检查发现左侧大脑中动脉（MCA）M1段有一个巨大的梭形动脉瘤，尺寸为20×12毫米。豆纹动脉起源于动脉瘤的近端和远端，但颞前动脉起源于动脉瘤。动脉瘤在M1段远端达到顶点，M1随即分成3支M2血管，下方的一支较大。由于豆纹动脉和颞前动脉的起源以及患者的年龄，与血流导向支架相比，旁路手术更受青睐。他接受了左额颞开颅术和眶骨切开术，暴露左侧颈外动脉，随后取出桡动脉移植物。打开外侧裂，暴露颅内颈内动脉以进行近端控制。追踪远端M2血管至动脉瘤。动脉瘤无法夹闭，遂对较大的下M2分支进行旁路手术，随后进行动脉瘤包裹术。将桡动脉移植物旁路从左颈外动脉放置到左MCA的M2段，随后进行夹子重建并闭塞MCA动脉瘤，同时保留颞前分支和豆纹血管。患者术后无并发症。术后1个月随访时，他情况良好，血管造影显示旁路通畅。本视频展示了采用旁路和包裹术治疗复杂梭形M1动脉瘤的过程。在手术前已获得患者的知情同意，其中包括对手术过程进行录像并出于教育目的进行传播。所有相关患者标识符也已从视频及随附的放射学幻灯片中删除。
