• World Neurosurg · Jul 2024

    One-stage combined open and endovascular treatment using a hybrid operating room is safe and effective for distal middle cerebral artery aneurysms.

    • Yuji Kushi, Hirotoshi Imamura, Takaaki Itazu, Saya Ozaki, Akihiro Niwa, Koji Shimonaga, Taichi Ikedo, Eika Hamano, Kiyofumi Yamada, Tsuyoshi Ohta, Tetsu Satow, Tetsuya Yamamoto, Koji Iihara, and Hiroharu Kataoka.
    • Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Department of Neurosurgery, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan. Electronic address: kussy6349@gmail.com.
    • World Neurosurg. 2024 Jul 1; 187: e731e739e731-e739.

    BackgroundAneurysms located in the distal middle cerebral artery (DMCA) are relatively rare and lack an established treatment strategy. For DMCA aneurysms, we performed a one-stage combined procedure of endovascular parent artery occlusion (PAO) with coils and superficial temporal artery to middle cerebral artery (STA-MCA) bypass in a hybrid operating room (HOR). The aim of this study was to evaluate the safety and efficacy of this procedure.MethodsCases of unruptured DMCA aneurysms treated with the one-stage combined PAO and STA-MCA bypass in HOR were retrospectively examined, and patients' and aneurysmal backgrounds, surgical procedures, and treatment outcomes were analyzed.ResultsSix patients were included in the study. The average maximum diameter of the aneurysms was 14.4 mm. One aneurysm was located at M2 and five at M3. All aneurysms had a fusiform shape. No cases were associated with infection, trauma, or malignant tumors. In all 6 cases, the combined PAO and STA-MCA bypass was successfully completed. No postoperative hemorrhagic complications occurred. A symptomatic ischemic complication occurred in 1 case whose symptom disappeared in a week. Three months after surgery, complete obliteration of the aneurysm and patency of the bypass was confirmed in all cases.ConclusionsThe one-stage combined PAO and STA-MCA bypass in the HOR is safe and effective for DMCA aneurysms, potentially serving as a treatment option for this complex aneurysm.Copyright © 2024 Elsevier Inc. All rights reserved.

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