Romanian Neurosurgery (Nov 2024)

SURGICAL CHALLENGES IN CLIPPING LARGE ANEURYSMS IN DISTAL ARTERIAL TERRITORIES

  • Mugurel Petrinel Radoi,
  • Milena-Monica Ilie,
  • Razvan-Adrian Covache-Busuioc,
  • Horia Petre Costin,
  • Luca-Andrei Glavan,
  • Matei Serban,
  • Antonio Daniel Corlatescu,
  • Corneliu Toader

DOI
https://doi.org/10.33962/roneuro-2024-122
Journal volume & issue
Vol. 38, no. Special Issue

Abstract

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Background By distal arterial territories we mean the arteries located after the main bifurcations of the cerebral arteries. They can occur at multiple sites throughout the course of distal arteries, but most often are found after the bifurcation of the M1 segment of the middle cerebral artery. Methods A retrospective review of 18 consecutive patients with large aneurysms located in distal arterial territories, treated by surgical clipping between 2019-2023, was performed. We consider aneurysm larger than 10 mm in diameter as large aneurysm. The data of all our consecutive patients were searched to obtain patient characteristics, details of the aneurysm size and orientation, treatment details, complications and follow up. At admission, the clinical condition of all patients was classified according to the Hunt and Hess scale. Clinical outcome was graded according to the modified Rankin scale. The follow-up period varied widely from 6 to 54 months (mean 24 months). Results Surgical clipping was performed for all aneurysms; only in 2 cases the aneurysm was unruptured. Three patients presented with significant hematoma which required the evacuation of the clot. Most large aneurysms were located in M2 or M3 segments of the MCA (16 patients). Post-operative control angiography was performed in 11 patients (61%), from which we reported a full occlusion of the aneurysm in 10 patients (90%). No perioperative mortality was recorded. The outcome was graded mRankin 0–2 in 83% of the cases (15 patients) at the end of the first postoperative months, and 94.4% (17 patients) at six months follow-up. The most important improvement was recorded for patients graded mRankin 1-2 at the first month follow-up. Conclusions The large size of the aneurysm, the size of the neck, as well as the reduced diameter of the parent vessel, represent important trials for the neurosurgeon in the correct clipping of the aneurysm. In some cases, sectioning of the aneurysm dome was necessary for successful clipping.

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