gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Treatment of a fusiform leftsided M2-Aneurysm with two STA-MCA anastomoses and coil occlusion: example of an interdisciplinary treatment strategy from a neurovascular center

Behandlung eines fusiformen linksseitigen M2-Aneurysmas mit 2 STA-MCA-Anastomosen und Coilokklusion: Beispiel für eine interdisziplinäre Behandlungsstrategie in einem neurovaskulärem Zentrum

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  • corresponding author L. Büntjen - Klinik für Neurochirurgie, Alfried-Krupp-Krankenhaus, Essen
  • W. Heienbrok - Klinik für Neurochirurgie, Alfried-Krupp-Krankenhaus, Essen
  • P. Jans - Klinik für Neurochirurgie, Alfried-Krupp-Krankenhaus, Essen
  • R. Laumer - Klinik für Neurochirurgie, Alfried-Krupp-Krankenhaus, Essen
  • W. Weber - Klinik für Neuroradiologie, Alfried-Krupp-Krankenhaus, Essen
  • D. Kühne - Klinik für Neuroradiologie, Alfried-Krupp-Krankenhaus, Essen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 09.126

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc343.shtml

Published: May 8, 2006

© 2006 Büntjen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: This case presentation demonstrates the complexity of vascular treatment strategies and the requirements for institutions in dealing with difficult aneurysm architecture.

Methods: A 42y.o. female was transferred from a university hospital to our neurovascular center. SAH was documented by CT scan. Cerebral angiography showed a large fusiform M2-aneurysm. The remarkably short M1 segment obviously contained the thalamic perforators. The preaneurysmatic M2 segment was slightly enlarged. MRI demonstrated that 2/3 of the aneurysm were occluded by a thrombus. Contrast injection into the parent vessel showed that appr. 70% of the MCA vascular territory including the broca region was supplied by the superior truncus of the MCA. Taking all radiologic findings into consideration a two-step interdisciplinary treatment was performed. The patient received two STA-MCA bypasses. Postoperative angiography demonstrated partial recanalisation of the aneurysm. Testocclusion of the parent vessel documented good collateral flow through the bypasses to the target area of brain parenchyma. The fusiform aneurysm was occluded with 24 platinium coils.

Results: Postinterventionally the trilingual patient showed mild transient broca aphasia and confused languages. Within five days this deficit resolved completely. The patient is expected to return to her former occupation.

Conclusions: In treating complex M2-aneurysms there is a necessity for an experienced team of dedicated vascular neurosurgeons and interventional neuroradiologists. Furthermore it is noted that extra-intracranial bypass surgery remains an important aspect in treating such aneurysms. Thus expertise in this field is still essential for vascular centers and microsurgical bypass training should not be neglected.