Multi-Lobulated MCA Artery Aneurysm |
Case #110: Flow-Assisted Neurosurgery |
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Courtesy F.T. Charbel, MD, Associate Professor, Dept. of Neurosurgery,
University of IL at Chicago
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Introduction |
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A 74-year-old woman with
subarachnoid hemorrhage grade III and a left multi-lobulated middle cerebral artery (MCA) aneurysm underwent surgery for aneurysm clipping.
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Multi-lobulated MCA Aneurysm - Baseline Flow Measurements |
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The aneurysm was exposed
and the vessels at risk of flow compromise were identified. These were two frontal branches of the MCA trifurcation which came off the aneurysm.
The Charbel Micro-flowprobeTM was then used to check baseline flow before clipping.
1st frontal branch baseline flow: 2.5 ml/min
2nd frontal branch baseline flow: 14 ml/min
Temporal branch baseline flow: 14 ml/min
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Aneurysm expose
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1st frontal branch baseline flow: 2.5 ml/min
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2nd frontal branch baseline flow: 14 ml/min
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Temporal branch baseline flow:14 ml/min
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Flow Compromised in Frontal Branch #2 |
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After clipping, the flow in the second frontal
branch was reduced by half, from 14 ml/min to 7 ml/min mean..
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Careful inspection of the take-off site of the vessel
showed it to be crinped by one of the aneurysm clips.
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Flow Restored to Baseline |
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The clips were readjusted
and flow in the 2nd frontal branch returned to baseline.
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Post-operative Images |
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The aneurysm was completely
treated without residual neck.
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Summary |
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In this case, flow in one of the frontal
branches of the MCA trifurcation was reduced by 50% after clipping. The clips were readjusted and flow was fully preserved as verified by the intraoperative flow
measurements with the Charbel Micro-flowprobe.
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