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- W4386437904 abstract "Complex cerebral revascularization techniques may be required for certain middle cerebral artery (MCA) aneurysms not amenable to conventional microsurgical clipping or endovascular techniques.1-8 Bypass with various trapping strategies may be used depending on the anatomy of perforating, parent, and daughter vessels. We describe the case of a 60-year-old woman who presented with a large unruptured, wide-necked MCA aneurysm with both frontal and temporal M2 branches incorporated in the aneurysm neck. The case presentation, operative nuances, and postoperative course with imaging are reviewed with detailed anatomical diagrams to orient the viewer (Video 1 {href:Single Video Player,role:media-player-id,content-type:play-in-place,position:float,orientation:portrait,label:VIDEO 1.,caption:The case presentation, surgical setup, operative video, postoperative course with imaging, and technical considerations and the literature on outcomes for cerebral revascularization techniques for the treatment of complex MCA aneurysms are reviewed.,object-id:[{pub-id-type:doi,id:},{pub-id-type:other,content-type:media-stream-id,id:1_mdb6yb06},{pub-id-type:other,content-type:media-source,id:Kaltura}]}). The patient had a foreshortened M1 with lenticulostriate perforators arising from the frontal M2. The patient underwent a pterional craniotomy, M2-M2 side-to-side backwall anastomosis, and external carotid artery-saphenous vein graft “triple-vessel” bypass (Video 2 {href:Single Video Player,role:media-player-id,content-type:play-in-place,position:float,orientation:portrait,label:VIDEO 2.,caption:A 2-dimensional flythrough of the 360° virtual reality (VR) model simulating the complex middle cerebral artery aneurysm is shown in collaboration with Surgical Theater – 360XR Visualization. The video demonstrates a large unruptured, wide-necked MCA aneurysm with both frontal and temporal M2 branches incorporated in the aneurysm neck. The patient had a foreshortened M1 with lenticulostriate perforators arising from the frontal M2. ©Surgical Theater, used with permission.,object-id:[{pub-id-type:doi,id:},{pub-id-type:other,content-type:media-stream-id,id:1_ymw3o3es},{pub-id-type:other,content-type:media-source,id:Kaltura}]} and 3 {href:Single Video Player,role:media-player-id,content-type:play-in-place,position:float,orientation:portrait,label:VIDEO 3.,caption:A 3-dimensional flythrough of the 360° virtual reality (VR) model simulating the complex middle cerebral artery aneurysm is shown in collaboration with Surgical Theater – 360XR Visualization. The video demonstrates a large unruptured, wide-necked MCA aneurysm with both frontal and temporal M2 branches incorporated in the aneurysm neck. The patient had a foreshortened M1 with lenticulostriate perforators arising from the frontal M2. ©Surgical Theater, used with permission. For best quality, please view in Chrome and adjust the in-frame video settings to 960p, or use highest available quality browser and setting.,object-id:[{pub-id-type:doi,id:},{pub-id-type:other,content-type:media-stream-id,id:1_fx527p8b},{pub-id-type:other,content-type:media-source,id:Kaltura}]}).9,10 The perforator-free temporal M2 and distal M1 were permanently clipped to trap the aneurysm while preserving retrograde flow to the frontal M2 and its perforating lenticulostriate arteries. Postoperative imaging showed a patent bypass with progressive thrombosis of the aneurysm and patency of the MCA candelabra and critical perforators. The technical considerations and the literature on outcomes for cerebral revascularization techniques for the treatment of complex MCA aneurysms are reviewed. The patient consented to the procedure and publication of this submission." @default.
- W4386437904 created "2023-09-06" @default.
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- W4386437904 date "2023-09-04" @default.
- W4386437904 modified "2023-10-18" @default.
- W4386437904 title "External Carotid Artery-Saphenous Vein Graft-M2/M2 Triple-Vessel Anastomosis and Trapping of Complex Middle Cerebral Artery Aneurysm: 360° Virtual Reality–Enhanced Operative Video" @default.
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- W4386437904 doi "https://doi.org/10.1227/ons.0000000000000857" @default.
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