Serrano-Rubio Alejandro, Rodríguez-Rubio Héctor A, López-Rodríguez Rodrigo, Balcázar Padrón Juan Carlos, Trujillo Sharon, Martínez-Cáceres Ana M, Hernández-Barrera Brenda Susana, Sánchez-Mata Rafael, Figueroa-Zelaya Daniel, Nathal Edgar
Vascular Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX.
Neurological Surgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX.
Cureus. 2024 Dec 26;16(12):e76435. doi: 10.7759/cureus.76435. eCollection 2024 Dec.
The bifurcation of the middle cerebral artery (MCA) is one of the most common sites for the formation of cerebral aneurysms, presenting significant challenges for surgical management. A primary concern in this area is the recurrence of aneurysms following surgical clipping, which necessitates a thorough investigation of the contributing factors. This study examined all cases of rebleeding from previously clipped MCA aneurysms among 195 surgically treated patients over an 11-year period. Our evaluation utilized detailed clinical records, imaging studies, and surgical video documentation. We specifically analyzed the direction of the aneurysmal dome, the type of clip used, clipping angles, and various factors that may contribute to rebleeding. Out of the 195 cases, three patients (1.5%) experienced rebleeding within four to 12 months following the initial clipping. Among these three cases, one was evaluated using digital subtraction angiography (DSA) post-clipping, while the other two were assessed with computed tomography angiography (CTA). The recurrence cases were characterized by atypical and aggressive patterns, involving rapid morphological changes that necessitated additional interventions. Surgical management for these cases included re-clipping or aneurysmectomy combined with revascularization procedures to address the recurring aneurysms. The findings of this study highlight the importance of understanding the relationship between anatomical and technical factors in the surgical management of MCA aneurysms. By identifying patterns associated with recurrence, this research seeks to improve decision-making processes and optimize strategies for managing recurrent aneurysms after clipping. Differences in imaging techniques may have affected the sensitivity in detecting small residual necks. This comprehensive approach can potentially enhance long-term outcomes for patients receiving treatment for MCA aneurysms.
大脑中动脉（MCA）分叉处是脑动脉瘤形成最常见的部位之一，给手术治疗带来了重大挑战。该区域的一个主要问题是手术夹闭后动脉瘤的复发，这就需要对相关因素进行全面调查。本研究调查了195例接受手术治疗的患者在11年期间内，既往夹闭的MCA动脉瘤再次出血的所有病例。我们的评估利用了详细的临床记录、影像学研究和手术视频资料。我们特别分析了动脉瘤瘤顶的方向、所用夹子的类型、夹闭角度以及可能导致再次出血的各种因素。在195例病例中，3例患者（1.5%）在初次夹闭后4至12个月内发生再次出血。在这3例病例中，1例在夹闭后使用数字减影血管造影（DSA）进行评估，另外2例则采用计算机断层血管造影（CTA）进行评估。复发病例的特点是非典型和侵袭性模式，涉及快速的形态学变化，需要额外的干预措施。这些病例的手术治疗包括再次夹闭或动脉瘤切除术并结合血管重建手术以处理复发性动脉瘤。本研究结果强调了在MCA动脉瘤手术治疗中理解解剖和技术因素之间关系的重要性。通过识别与复发相关的模式，本研究旨在改善决策过程并优化夹闭后复发性动脉瘤的管理策略。成像技术的差异可能影响了检测小残留瘤颈的敏感性。这种综合方法有可能提高接受MCA动脉瘤治疗患者的长期疗效。
