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Introduction and importance <p>This study aims to evaluate the microsuture technique in treating giant dissecting aneurysms of the middle cerebral artery (MCA) trunk, particularly in cases involving perforators—a key surgical challenge.</p> Methods <p>This reconstruction of the MCA trunk was performed in four patients with giant dissecting aneurysms using a microsuture technique. The fragile wall of the dissecting aneurysm was meticulously excised while preserving the perforating arteries originating from the aneurysm body. Subsequently, a bypass was established from the internal maxillary artery (IMA) to the distal MCA (or specify the exact branch if applicable). This surgical approach achieved temporary vascular occlusion while maintaining distal perfusion, thereby preventing ischemia in the territory distal to the aneurysm during its definitive management.</p> Outcomes <p>Among the four patients, three had surgically clipped aneurysms of the MCA trunk, while the remaining patient presented with severe headaches and left lower limb paralysis. All patients underwent microsuture of the MCA trunk and subsequently experienced uneventful postoperative recoveries without neurological deficits. Postoperative angiography demonstrated successful MCA trunk reconstruction with complete dissecting aneurysm resolution in three cases. In the remaining patient, although MCA reconstruction was not radiographically visible, patency of the IMA-to-M2 segment bypass was confirmed. Follow-up imaging revealed: At six-year follow-up, one patient exhibited both a patent IMA-to-M2 bypass and reconstructed M1 trunk on CT angiography; Two patients showed M1 trunk restoration with aneurysm disappearance at three-month follow-up; One patient maintained a patent IMA-to-M2 bypass without visualized MCA trunk. No ischemic events occurred in any patient, presumably due to preserved perforating arteries originating from the reconstructed MCA trunks.</p> Conclusion <p>Some large dissecting aneurysms of the MCA trunk can be effectively treated with the microsuture technique by reconstructing the trunk and preserving its perforators.</p>

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Giant dissecting aneurysm of the middle cerebral artery (MCA): report of four cases–successfully treated by microsuture technique

  • 期刊论文

  • 发表日期：

    2025年10月18日

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  • Ting Lei,
  • Xiang’en Shi,
  • Fangjun Liu,
  • Yuming Sun,
  • Mengqing Hu,
  • Xin Xiang

摘要

Introduction and importance

This study aims to evaluate the microsuture technique in treating giant dissecting aneurysms of the middle cerebral artery (MCA) trunk, particularly in cases involving perforators—a key surgical challenge.

Methods

This reconstruction of the MCA trunk was performed in four patients with giant dissecting aneurysms using a microsuture technique. The fragile wall of the dissecting aneurysm was meticulously excised while preserving the perforating arteries originating from the aneurysm body. Subsequently, a bypass was established from the internal maxillary artery (IMA) to the distal MCA (or specify the exact branch if applicable). This surgical approach achieved temporary vascular occlusion while maintaining distal perfusion, thereby preventing ischemia in the territory distal to the aneurysm during its definitive management.

Outcomes

Among the four patients, three had surgically clipped aneurysms of the MCA trunk, while the remaining patient presented with severe headaches and left lower limb paralysis. All patients underwent microsuture of the MCA trunk and subsequently experienced uneventful postoperative recoveries without neurological deficits. Postoperative angiography demonstrated successful MCA trunk reconstruction with complete dissecting aneurysm resolution in three cases. In the remaining patient, although MCA reconstruction was not radiographically visible, patency of the IMA-to-M2 segment bypass was confirmed. Follow-up imaging revealed: At six-year follow-up, one patient exhibited both a patent IMA-to-M2 bypass and reconstructed M1 trunk on CT angiography; Two patients showed M1 trunk restoration with aneurysm disappearance at three-month follow-up; One patient maintained a patent IMA-to-M2 bypass without visualized MCA trunk. No ischemic events occurred in any patient, presumably due to preserved perforating arteries originating from the reconstructed MCA trunks.

Conclusion

Some large dissecting aneurysms of the MCA trunk can be effectively treated with the microsuture technique by reconstructing the trunk and preserving its perforators.