Article
Use of neuronavigation for superficial temporal artery to cortical branch of middle cerebral artery (STA-M4) revascularisation in the treatment of fusiform aneurysms of middle cerebral artery (MCA) – a series of 6 patients
Neuronavigierter STA-M4 Bypass zur Behandlung von fusiformen MCA Aneurysmen – eine Serie von 6 Patienten
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Authors
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Angelo Tortora
- Universitätsklinikum Düsseldorf, Neurochirurgie, Düsseldorf, Deutschland
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Jan Frederick Cornelius
- Heinrich-Heine-Universität Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Hans-Jakob Steiger
- Heinrich-Heine-Universität Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Daniel Hänggi
- Heinrich-Heine-Universität Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Athanasios Petridis
- Heinrich-Heine-Universität Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: STA-M4 bypasscombined with trapping is a versatile technique in the treatment of fusiform aneurysms of MCA. Intraoperativeidentificationofthe right cortical recipient arteryoriginating from the lesion located in the distal fissure may be demanding. Furthermore, the exploration of the aneurysm prior to revascularization is risky in ruptured cases. We present a series of 6 patients with fusiform MCA aneurysm in which the revascularization was performed with guidance of neuronavigation.
Methods: The preoperative CTA orDSA were uploaded on neuronavigation system. After intraoperative laser surface-based registration of the patient, the donor STA branch, the recipient artery and the craniotomy were located on the skin surface the perform a tailored skin incision. After dissection of STA branch, craniotomy and dura opening, the recipient M4 branch distal to aneurysm was localized by neuronavigation. After vascular reconstruction the aneurysm was excluded from the circulation.
Results: Between January 2016 and November 2019 we treated 6 patients with fusiform MCA aneurysm and therefore STA-M4 bypass and trapping. The mean age was 38.14 years. The aneurysm was located in M2 segment in 5 cases and in M3 segment in one patient. The aneurysm was ruptured in 3 patients, caused epilepsy in 2 patients and was an incidental finding in the1 case. In all patients the neuronavigation was used to plan the skin incision after localizing the course of STA branches without need of Doppler and according to the site of craniotomy. Only in one case a standard pterional craniotomy was sufficient. In all other cases the location of thelesion in the distal sylvian fissure or the distal location of the recipient M4 branch on angular or supramarginal Gyri required a tailored approach. In all patients the cortical recipient artery for the anastomosis was correctly localized on the brain surface and prepared for bypass prior of aneurysm dissection. Furthermore in four cases neuronavigation was used to localize the aneurysm in the distal Sylvian fissure allowing just a selective opening.
Conclusion: Neuronavigation is a useful tool for this complex surgery. Itallows straightforward identification of the recipient artery, tailored Sylvian dissection and increased safety of the procedure.
