| Analysis of Angiographic Findings and Postoperative Stroke in Proximal Middle Cerebral Artery Aneurysms in Elderly Patients |
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Hwan-Joo Lee1 , Dong-Hyuk Park1 , Shin-Hyuk Kang1 , Dong-Jun Lim1 , Taek-Hyun Kwon1 , Jeong-Hyun Lee2 , Yong-Gu Chung1 |
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1Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
2Department of Anesthesiology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea |
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| Abstract |
Objective
It is critical for the aneurysm surgery to understand the microanatomy of the proximal middle cerebral artery (M1) and its early branches. we collected cases from 2001 to 2009 and analyzed statistically the angiographic findings, patients’ factors, and postoperative stroke in M1 aneurysms.
Methods
Twenty-nine patientsolder than 65 years with M1 aneurysms presented to our institution from January 2001 toDecember 2009. We examined the general characteristics, angiographic features of the M1 aneurysms, such as site, size, direction, and their association with early branches and the development of postoperative stroke.
Results
Of the 29 patients with M1 aneurysms, eighteen were women and eleven were men. Twenty-twoof the aneurysms had ruptured prior to presentation. Multiple aneurysms were observed in ten of the patients. Angiography showed that 17 of the aneurysms were less than 5 mm in size, and most of the aneurysmal projections were superior (23 out of 33 aneurysms). Twentyof the aneurysms involved early frontal branches and four involved the lenticulostriate arteries. Postoperative infarction was seen in twelve patients. Eight of the 10 patients showed either no or slight neurological deficits at the follow-up visit. Two patients had a total MCA infarction and a posterior fossa infarction, respectively and they were not related with the M1 aneurysm surgery. There was no statistical relation between the surgery-related stroke and sex, hypertension, Hunt-Hess (H-H) classification, Fisher grade, rupture or not, and aneurysm characteristics such as size, direction, location and multiplicity, even though the location (early frontal branch) was slightly related with the surgery-related stroke (chi-square, p=0.06).
Conclusion
Classical stroke risk factors such as hypertension, patient’s factors such as sex, and subarachnoid hemorrhage-related factors such as H-H classification and Fisher grade did not affect the development of the postoperative stroke. |
| Key Words:
Proximal middle cerebral artery aneurysmㆍPost-operative stroke |
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