Tag: Occlusion

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Reversal of Middle Cerebral Artery Stenosis by Minimally Invasive Intracerebral Hematoma Evacuation

Neurosurgery Practice 2024;5(2):e00087.

Acute intracerebral hematomas are known to induce significant mass effects within the brain, leading to critical complications such as cerebral midline shift, herniation, and increased intracranial pressure. The timing and efficacy of intracerebral hematoma evacuation remain subjects of ongoing debate in current literature.

CLINICAL PRESENTATION: In our case report, we present a 74-year-old female patient diagnosed with basal ganglia hematoma. The resultant mass effect from the intracerebral hematoma led to middle cerebral artery (MCA) stenosis. Notably, early-stage minimally invasive hematoma evacuation was pivotal in facilitating successful revascularization of the MCA.

CONCLUSION: Our case underscores the significance of prompt identification and management of MCA stenosis arising from intracerebral hematoma. Early intervention through minimally invasive hematoma evacuation proved instrumental in achieving successful MCA revascularization. These findings emphasize the critical role of timely interventions in mitigating potential complications associated with intracerebral hematoma.

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Endovascular and Surgical Treatment of Internal Carotid Bifurcation Aneurysms: Comparison of Results, Outcome, and Mid-Term Follow-up

Categorization of aneurysms by their origin and projection

Neurosurgery 76:540–551, 2015

Aneurysms of the internal carotid artery (ICA) bifurcation are rare, and no studies have compared patient outcomes after endovascular vs surgical treatment.

OBJECTIVE: To report the safety, efficacy, and follow-up outcome of these 2 treatment options for patients with ICA bifurcation aneurysms.

METHODS: Patient and aneurysm characteristics, treatment results, and follow-up outcomes (at 30 months) were analyzed from patient records and review of imaging findings.

RESULTS: A total of 58 patients with ICA bifurcation aneurysms were treated. By interdisciplinary consensus, 30 aneurysms were assigned for coiling and 28 for clipping. Patients who underwent surgical clipping were younger and had larger aneurysms. More patients were assigned to coiling if their aneurysms originated only from the ICA bifurcation or projected superiorly. For the combined angiographic endpoint, complete and nearly complete occlusion (Raymond-Roy I + II), similar rates of 96% (coiling) or 100% (clipping) could be achieved. Raymond-Roy I occlusion occurred more often after clipping (79% vs 41% coiling). Follow-up of the endovascular group showed minor recanalization of the aneurysm neck (Raymond-Roy II) in 42%. One patient (4%) showed a major recanalization (Raymond-Roy III) and needed re-treatment. For incidental findings, no bleeding complications or new persistent neurological deficits occurred during follow-up.

CONCLUSION: Treatment of ICA bifurcation aneurysms after interdisciplinary assignment to clipping or coiling is effective and safe. Despite significantly more minor recanalizations after coiling, the re-treatment rate was very low, and no bleeding was observed during follow-up. Multivariate analysis revealed that origin only from the ICA bifurcation was an independent predictor of aneurysm recanalization after endovascular treatment.

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