Treatment of aneurysms by excision or trapping with arterial reimplantation or interpositional grafting

Report of three cases

Sang Youl Lee M.D., Ph.D.1 and Laligam N. Sekhar M.D.1
View More View Less
  • 1 Department of Neurological Surgery, The George Washington University Medical Center, Washington, D.C.
Page Range:
178–185
Volume/Issue:
Volume 85: Issue 1
DOI link:
https://doi.org/10.3171/jns.1996.85.1.0178
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Click here for subscription options

  • Purchase Now

    USD  $45.00

  • JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

    USD  $515.00

  • JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

    USD  $612.00
Print or Print + Online

✓ The authors report three cases of ruptured, large or giant aneurysms that were treated by excision or trapping, followed by revascularization of distal vessels by means of arterial reimplantation or superficial temporal artery interpositional grafting.

In the first case, a large serpentine aneurysm arising from the anterior temporal branch of the right middle cerebral artery (MCA) was excised and the distal segment of the anterior temporal artery was reimplanted into one of the branches of the MCA. In the second case, a giant aneurysm, fusiform in shape, arose from the rolandic branch of the MCA. This aneurysm was totally excised and the M3 branch in which it had been contained was reconstructed with an arterial interpositional graft. In the third case the patient, who presented with a subarachnoid hemorrhage, had a dissecting aneurysm that involved the distal portion of the left vertebral artery. In this case the posterior inferior cerebellar artery (PICA) arose from the wall of the aneurysm and coursed onward to supply the brainstem. This aneurysm was managed by trapping and the PICA was reimplanted into the ipsilateral large anterior inferior cerebellar artery. None of the patients suffered a postoperative stroke and all recovered to a good or excellent postoperative condition.

These techniques allowed complete isolation of the aneurysm from the normal blood circulation and preserved the blood flow through the distal vessel that came out of the aneurysm. These techniques should be considered as alternatives when traditional means of cerebral revascularization are not feasible.

Volume 85: Issue 1 (Jul 1996)

in Journal of Neurosurgery
Cover Journal of Neurosurgery

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Click here for subscription options

  • JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

    USD  $515.00

  • JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

    USD  $612.00
Print or Print + Online
  • 1.

    Ammerman BJ, & Smith DR: Giant fusiform middle cerebral aneurysm: successful treatment utilizing microvascular bypass. Surg Neurol 7:255–257, 1977 Ammerman BJ, Smith DR: Giant fusiform middle cerebral aneurysm: successful treatment utilizing microvascular bypass. Surg Neurol 7:255–257, 1977

    • Search Google Scholar
    • Export Citation
  • 2.

    Aoki N, & Sakai T: Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 21:1628–1631, 1990 Aoki N, Sakai T: Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 21:1628–1631, 1990

    • Search Google Scholar
    • Export Citation
  • 3.

    Artero JC, , Ausman JI, & Dujovny M, et al: Middle cerebral artery reconstruction. Surg Neurol 24:5–11, 1985 Artero JC, Ausman JI, Dujovny M, et al: Middle cerebral artery reconstruction. Surg Neurol 24:5–11, 1985

    • Search Google Scholar
    • Export Citation
  • 4.

    Ausman JI, , Diaz FG, & Mullan S, et al: Posterior inferior to inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm. Case report. J Neurosurg 73:462–465, 1990 Ausman JI, Diaz FG, Mullan S, et al: Posterior inferior to inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm. Case report. J Neurosurg 73:462–465, 1990

    • Search Google Scholar
    • Export Citation
  • 5.

    Berger MS, & Wilson CB: Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61:882–894, 1984 Berger MS, Wilson CB: Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61:882–894, 1984

    • Search Google Scholar
    • Export Citation
  • 6.

    Casasco AE, , Aymard A, & Gobin P, et al: Selective endovascular treatment of 71 intracranial aneurysms with platinum coils. J Neurosurg 79:3–10, 1993 Casasco AE, Aymard A, Gobin P, et al: Selective endovascular treatment of 71 intracranial aneurysms with platinum coils. J Neurosurg 79:3–10, 1993

    • Search Google Scholar
    • Export Citation
  • 7.

    Charbel FT, , Ausman JI, & Diaz FG, et al: Temporary clipping in aneurysm surgery: technique and results. Surg Neurol 36:83–90, 1991 Charbel FT, Ausman JI, Diaz FG, et al: Temporary clipping in aneurysm surgery: technique and results. Surg Neurol 36:83–90, 1991

    • Search Google Scholar
    • Export Citation
  • 8.

    De Jong THR, , Tulleken CAF, & Ramos L: Place of the extra-intra-cranial-bypass in aneurysm-surgery. Clin Neurol Neurosurg 91:221–228, 1989 De Jong THR, Tulleken CAF, Ramos L: Place of the extra-intra-cranial-bypass in aneurysm-surgery. Clin Neurol Neurosurg 91:221–228, 1989

    • Search Google Scholar
    • Export Citation
  • 9.

    Dolenc V: End-to-end suture of the posterior inferior cerebellar artery after the excision of a large aneurysm: case report. Neurosurgery 11:690–693, 1982 Dolenc V: End-to-end suture of the posterior inferior cerebellar artery after the excision of a large aneurysm: case report. Neurosurgery 11:690–693, 1982

    • Search Google Scholar
    • Export Citation
  • 10.

    Drake CG, , Peerless SJ, & Ferguson GG: Hunterian proximal arterial occlusion for giant aneurysm of the carotid circulation. J Neurosurg 81:656–665, 1994 Drake CG, Peerless SJ, Ferguson GG: Hunterian proximal arterial occlusion for giant aneurysm of the carotid circulation. J Neurosurg 81:656–665, 1994

    • Search Google Scholar
    • Export Citation
  • 11.

    Durward QJ: Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation. Case report. J Neurosurg 82:137–139, 1995 Durward QJ: Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation. Case report. J Neurosurg 82:137–139, 1995

    • Search Google Scholar
    • Export Citation
  • 12.

    Ferguson GG, , Drake CG, & Peerless SJ: Extracranial-intracranial arterial bypass in the treatment of “giant” intracranial aneurysms. Stroke 8:11, 1977 (Abstract) Ferguson GG, Drake CG, Peerless SJ: Extracranial-intracranial arterial bypass in the treatment of “giant” intracranial aneurysms. Stroke 8:11, 1977 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 13.

    Fodstad H, , Liliequist B, & Wirell S, et al: Giant serpentine intracranial aneurysm after carotid ligation. Case report. J Neurosurg 49:903–909, 1978 Fodstad H, Liliequist B, Wirell S, et al: Giant serpentine intracranial aneurysm after carotid ligation. Case report. J Neurosurg 49:903–909, 1978

    • Search Google Scholar
    • Export Citation
  • 14.

    Friedman AH, & Drake CG: Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60:325–334, 1984 Friedman AH, Drake CG: Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60:325–334, 1984

    • Search Google Scholar
    • Export Citation
  • 15.

    Gelber BR, & Sundt TM Jr: Treatment of intracavernous and giant carotid aneurysms by combined internal carotid ligation and extra- to intracranial bypass. J Neurosurg 52:1–10, 1980 Gelber BR, Sundt TM Jr: Treatment of intracavernous and giant carotid aneurysms by combined internal carotid ligation and extra- to intracranial bypass. J Neurosurg 52:1–10, 1980

    • Search Google Scholar
    • Export Citation
  • 16.

    Greene KA, , Anson JA, & Spetzler RF: Giant serpentine middle cerebral artery aneurysm treated by extracranial-intracranial bypass. Case report. J Neurosurg 78:974–978, 1993 Greene KA, Anson JA, Spetzler RF: Giant serpentine middle cerebral artery aneurysm treated by extracranial-intracranial bypass. Case report. J Neurosurg 78:974–978, 1993

    • Search Google Scholar
    • Export Citation
  • 17.

    Haddad GF, & Haddad FS: Cerebral giant serpentine aneurysm: case report and review of the literature. Neurosurgery 23:92–97, 1988 Haddad GF, Haddad FS: Cerebral giant serpentine aneurysm: case report and review of the literature. Neurosurgery 23:92–97, 1988

    • Search Google Scholar
    • Export Citation
  • 18.

    Harbaugh R, , Schlusselberg DS, & Jeffery R, et al: Three-dimensional computed tomographic angiography in the preoperative evaluation of cerebrovascular lesions. Neurosurgery 36:320–327, 1995 Harbaugh R, Schlusselberg DS, Jeffery R, et al: Three-dimensional computed tomographic angiography in the preoperative evaluation of cerebrovascular lesions. Neurosurgery 36:320–327, 1995

    • Search Google Scholar
    • Export Citation
  • 19.

    Higashida RT, , Halbach VV, & Dowd CF, et al: Interventional neurovascular treatment of a giant intracranial aneurysm using platinum microcoils. Surg Neurol 35:64–68, 1991 Higashida RT, Halbach VV, Dowd CF, et al: Interventional neurovascular treatment of a giant intracranial aneurysm using platinum microcoils. Surg Neurol 35:64–68, 1991

    • Search Google Scholar
    • Export Citation
  • 20.

    Hopkins LN, , Budny JL, & Castellani D: Extracranial-intracranial arterial bypass and basilar artery ligation in the treatment of giant basilar artery aneurysms. Neurosurgery 13:189–194, 1983 Hopkins LN, Budny JL, Castellani D: Extracranial-intracranial arterial bypass and basilar artery ligation in the treatment of giant basilar artery aneurysms. Neurosurgery 13:189–194, 1983

    • Search Google Scholar
    • Export Citation
  • 21.

    Hopkins LN, & Grand W: Extracranial-intracranial arterial bypass in the treatment of aneurysms of the carotid and middle cerebral arteries. Neurosurgery 5:21–31, 1979 Hopkins LN, Grand W: Extracranial-intracranial arterial bypass in the treatment of aneurysms of the carotid and middle cerebral arteries. Neurosurgery 5:21–31, 1979

    • Search Google Scholar
    • Export Citation
  • 22.

    Hunt WE, & Hess RM: Surgical risks as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20, 1968 Hunt WE, Hess RM: Surgical risks as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20, 1968

    • Search Google Scholar
    • Export Citation
  • 23.

    Isla A, , Alvarez F, & Roda JM: Serpentine aneurysm: regrowth after a superficial temporal artery—middle cerebral artery bypass and internal carotid artery ligation: case report. Neurosurgery 34:1072–1074, 1994 Isla A, Alvarez F, Roda JM: Serpentine aneurysm: regrowth after a superficial temporal artery—middle cerebral artery bypass and internal carotid artery ligation: case report. Neurosurgery 34:1072–1074, 1994

    • Search Google Scholar
    • Export Citation
  • 24.

    Jabre A, & Symon L: Temporary vascular occlusion during aneurysm surgery. Surg Neurol 27:47–63, 1987 Jabre A, Symon L: Temporary vascular occlusion during aneurysm surgery. Surg Neurol 27:47–63, 1987

    • Search Google Scholar
    • Export Citation
  • 25.

    Khayata MH, , Spetzler RF, & Mooy JJA: Combined surgical and endovascular treatment of a giant vertebral artery aneurysm in a child: case report. J Neurosurg 81:304–307, 1994 Khayata MH, Spetzler RF, Mooy JJA: Combined surgical and endovascular treatment of a giant vertebral artery aneurysm in a child: case report. J Neurosurg 81:304–307, 1994

    • Search Google Scholar
    • Export Citation
  • 26.

    Kimura M, , Tanaka A, & Matsuno H, et al: Use of STA-MCA anastomosis for clipping of giant middle cerebral artery aneurysm—case report. Neurol Med Chir 33:774–778, 1993 Kimura M, Tanaka A, Matsuno H, et al: Use of STA-MCA anastomosis for clipping of giant middle cerebral artery aneurysm—case report. Neurol Med Chir 33:774–778, 1993

    • Search Google Scholar
    • Export Citation
  • 27.

    Kitanaka C, , Morimoto T, & Sasaki T, et al: Rebleeding from vertebral artery dissection after proximal clipping. Case report. J Neurosurg 77:466–468, 1992 Kitanaka C, Morimoto T, Sasaki T, et al: Rebleeding from vertebral artery dissection after proximal clipping. Case report. J Neurosurg 77:466–468, 1992

    • Search Google Scholar
    • Export Citation
  • 28.

    Kitanaka C, , Sasaki T, & Eguchi T, et al: Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations. Neurosurgery 34:620–627, 1994 Kitanaka C, Sasaki T, Eguchi T, et al: Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations. Neurosurgery 34:620–627, 1994

    • Search Google Scholar
    • Export Citation
  • 29.

    Knuckey NW, , Haas R, & Jenkins R, et al: Thrombosis of difficult intracranial aneurysms by the endovascular placement of platinum-Dacron microcoils. J Neurosurg 77:43–50, 1992 Knuckey NW, Haas R, Jenkins R, et al: Thrombosis of difficult intracranial aneurysms by the endovascular placement of platinum-Dacron microcoils. J Neurosurg 77:43–50, 1992

    • Search Google Scholar
    • Export Citation
  • 30.

    Momma F, , Wang AD, & Symon L: Effects of temporary arterial occlusion on somatosensory evoked responses in aneurysm surgery. Surg Neurol 27:343–352, 1987 Momma F, Wang AD, Symon L: Effects of temporary arterial occlusion on somatosensory evoked responses in aneurysm surgery. Surg Neurol 27:343–352, 1987

    • Search Google Scholar
    • Export Citation
  • 31.

    Nicholas DA: Endovascular treatment of the acutely ruptured intracranial aneurysm. J Neurosurg 79:1–2, 1993 Nicholas DA: Endovascular treatment of the acutely ruptured intracranial aneurysm. J Neurosurg 79:1–2, 1993

    • Search Google Scholar
    • Export Citation
  • 32.

    Ramina R, , Arruda WO, & Prestes ACF, et al: Arterial graft reconstruction in an aneurysm of the middle cerebral artery. Neurosurgery 26:327–329, 1990 Ramina R, Arruda WO, Prestes ACF, et al: Arterial graft reconstruction in an aneurysm of the middle cerebral artery. Neurosurgery 26:327–329, 1990

    • Search Google Scholar
    • Export Citation
  • 33.

    Rosenwasser RH: Comment on Tsukahara T, Wada H, Satake K, et al: Proximal balloon occlusion for dissecting vertebral aneurysms accompanied by subarachnoid hemorrhage. Neurosurgery 36:919, 1995 Rosenwasser RH: Comment on Tsukahara T, Wada H, Satake K, et al: Proximal balloon occlusion for dissecting vertebral aneurysms accompanied by subarachnoid hemorrhage. Neurosurgery 36:919, 1995

    • Search Google Scholar
    • Export Citation
  • 34.

    Sadik AK, , Budzilovich GN, & Shulman K: Giant aneurysm of middle cerebral artery. A case report. J Neurosurg 22:177–181, 1965 Sadik AK, Budzilovich GN, Shulman K: Giant aneurysm of middle cerebral artery. A case report. J Neurosurg 22:177–181, 1965

    • Search Google Scholar
    • Export Citation
  • 35.

    Segal HD, & McLaurin RL: Giant serpentine aneurysm. Report of two cases. J Neurosurg 46:115–120, 1977 Segal HD, McLaurin RL: Giant serpentine aneurysm. Report of two cases. J Neurosurg 46:115–120, 1977

    • Search Google Scholar
    • Export Citation
  • 36.

    Sekhar LN, , Iwai Y, & Wright DC, et al: Vein graft replacement of the middle cerebral artery after unsuccessful embolectomy: case report. Neurosurgery 33:723–726, 1993 Sekhar LN, Iwai Y, Wright DC, et al: Vein graft replacement of the middle cerebral artery after unsuccessful embolectomy: case report. Neurosurgery 33:723–726, 1993

    • Search Google Scholar
    • Export Citation
  • 37.

    Sekhar LN, , Kalia KK, & Yonas H, et al: Cranial base approaches to intracranial aneurysms in the subarachnoid space. Neurosurgery 35:472–481, 1994 Sekhar LN, Kalia KK, Yonas H, et al: Cranial base approaches to intracranial aneurysms in the subarachnoid space. Neurosurgery 35:472–481, 1994

    • Search Google Scholar
    • Export Citation
  • 38.

    Sen C, & Sekhar LN: Direct vein graft reconstruction of the cavernous, petrous, and upper cervical internal carotid artery: lessons learned from 30 cases. Neurosurgery 30:732–743, 1992 Sen C, Sekhar LN: Direct vein graft reconstruction of the cavernous, petrous, and upper cervical internal carotid artery: lessons learned from 30 cases. Neurosurgery 30:732–743, 1992

    • Search Google Scholar
    • Export Citation
  • 39.

    Spetzler RF, & Carter LP: Revascularization and aneurysm surgery: current status. Neurosurgery 16:111–116, 1985 Spetzler RF, Carter LP: Revascularization and aneurysm surgery: current status. Neurosurgery 16:111–116, 1985

    • Search Google Scholar
    • Export Citation
  • 40.

    Spetzler RF, , Schuster H, & Roski RA: Elective extracranial-intracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery. J Neurosurg 53:22–27, 1980 Spetzler RF, Schuster H, Roski RA: Elective extracranial-intracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery. J Neurosurg 53:22–27, 1980

    • Search Google Scholar
    • Export Citation
  • 41.

    Standard SC, & Hopkins LN: Comment on Tsukahara T, Wada H, Satake K, et al: Proximal balloon occlusion for dissecting vertebral aneurysms accompanied by subarachnoid hemorrhage. Neurosurgery 36:919, 1995 Standard SC, Hopkins LN: Comment on Tsukahara T, Wada H, Satake K, et al: Proximal balloon occlusion for dissecting vertebral aneurysms accompanied by subarachnoid hemorrhage. Neurosurgery 36:919, 1995

    • Search Google Scholar
    • Export Citation
  • 42.

    Sundt TM Jr, , Piepgras DG, & Marsh WR, et al: Saphenous vein bypass grafts for giant aneurysms and intracranial occlusive disease. J Neurosurg 65:439–450, 1986 Sundt TM Jr, Piepgras DG, Marsh WR, et al: Saphenous vein bypass grafts for giant aneurysms and intracranial occlusive disease. J Neurosurg 65:439–450, 1986

    • Search Google Scholar
    • Export Citation
  • 43.

    Suzuki S, , Takahashi T, & Ohkuma H, et al: Management of giant serpentine aneurysms of the middle cerebral artery—review of literature and report of a case successfully treated by STA-MCA anastomosis only. Acta Neurochir 117:23–29, 1992 Suzuki S, Takahashi T, Ohkuma H, et al: Management of giant serpentine aneurysms of the middle cerebral artery—review of literature and report of a case successfully treated by STA-MCA anastomosis only. Acta Neurochir 117:23–29, 1992

    • Search Google Scholar
    • Export Citation
  • 44.

    Takai N, , Ezuka I, & Sorimachi T, et al: Vertebral artery dissecting aneurysm rebleeding after proximal occlusion—case report. Neurol Med Chir 33:765–768, 1993 Takai N, Ezuka I, Sorimachi T, et al: Vertebral artery dissecting aneurysm rebleeding after proximal occlusion—case report. Neurol Med Chir 33:765–768, 1993

    • Search Google Scholar
    • Export Citation
  • 45.

    Tampieri D, , Leblanc R, & Oleszek J, et al: Three-dimensional computed tomographic angiography of cerebral aneurysms. Neurosurgery 36:749–755, 1995 Tampieri D, Leblanc R, Oleszek J, et al: Three-dimensional computed tomographic angiography of cerebral aneurysms. Neurosurgery 36:749–755, 1995

    • Search Google Scholar
    • Export Citation
  • 46.

    Terao H, & Muraoka I: Giant aneurysm of the middle cerebral artery containing an important blood channel. Case report. J Neurosurg 37:352–356, 1972 Terao H, Muraoka I: Giant aneurysm of the middle cerebral artery containing an important blood channel. Case report. J Neurosurg 37:352–356, 1972

    • Search Google Scholar
    • Export Citation
  • 47.

    Tomasello F, , Albanese V, & Cioffi FA: Giant serpentine aneurysm: a separate entity. Surg Neurol 12:429–432, 1979 Tomasello F, Albanese V, Cioffi FA: Giant serpentine aneurysm: a separate entity. Surg Neurol 12:429–432, 1979

    • Search Google Scholar
    • Export Citation
  • 48.

    Umansky F, , Juarez SM, & Dujovny M, et al: Microsurgical anatomy of the proximal segments of the middle cerebral artery. J Neurosurg 61:458–467, 1984 Umansky F, Juarez SM, Dujovny M, et al: Microsurgical anatomy of the proximal segments of the middle cerebral artery. J Neurosurg 61:458–467, 1984

    • Search Google Scholar
    • Export Citation
  • 49.

    Yamada K, , Hayakawa T, & Ushio Y, et al: Therapeutic occlusion of the vertebral artery for unclippable vertebral aneurysm: relationship between site of occlusion and clinical outcome. Neurosurgery 15:834–838, 1984 Yamada K, Hayakawa T, Ushio Y, et al: Therapeutic occlusion of the vertebral artery for unclippable vertebral aneurysm: relationship between site of occlusion and clinical outcome. Neurosurgery 15:834–838, 1984

    • Search Google Scholar
    • Export Citation
  • 50.

    Yamaura A, , Watanabe Y, & Saeki N: Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183–188, 1990 Yamaura A, Watanabe Y, Saeki N: Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183–188, 1990

    • Search Google Scholar
    • Export Citation
  • 51.

    Yokoh A, , Ausman JI, & Dujovny M, et al: Anterior cerebral artery reconstruction. Neurosurgery 19:26–34, 1986 Yokoh A, Ausman JI, Dujovny M, et al: Anterior cerebral artery reconstruction. Neurosurgery 19:26–34, 1986

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 404 129 16
Full Text Views 271 18 3
PDF Downloads 106 12 3
EPUB Downloads 0 0 0