{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T22:33:42Z","timestamp":1776724422796,"version":"3.51.2"},"reference-count":49,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2014,2]]},"abstract":"\nObject<\/jats:title>\nThe object of this study was to describe the authors' institutional experience in the treatment of complex middle cerebral artery (MCA) aneurysms necessitating bypass and vessel sacrifice.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nCases in which patients with MCA aneurysms were treated with a combination of bypass and parent artery sacrifice were reviewed retrospectively.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nThe authors identified 24 patients (mean age 46 years) who were treated with bypass and parent artery sacrifice. The aneurysms were located in the M1<\/jats:sub> segment in 7 patients, MCA bifurcation in 8, and more distally in 9. The mean aneurysm diameter was 30 mm (range 7\u201360 mm, median 26 mm). There were 8 saccular and 16 fusiform aneurysms.<\/jats:p>\nTwenty-one extracranial-intracranial and 4 intracranial-intracranial bypasses were performed. Partial or total trapping (only) of the parent artery was performed in 17 cases, trapping with resection of aneurysm in 3, and aneurysm clipping with sacrifice of an M2<\/jats:sub> branch in 4.<\/jats:p>\nThe mean follow-up period was 27 months. The aneurysm obliteration rate was 100%. No recanalization of the aneurysms was detected during follow-up.<\/jats:p>\nThere was 1 perioperative death (4% mortality rate) and 6 cerebrovascular accidents, causing permanent morbidity in 5 patients. The median modified Rankin Scale score of patients with an M1<\/jats:sub> aneurysm increased from 0 preoperatively to 2 at latest follow-up, while the score was unchanged in other patients. Most of the permanent deficits were associated with M1<\/jats:sub> aneurysms. Twenty-one patients (88%) had good outcome as defined by a Glasgow Outcome Scale score of 4 or 5.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nBypass in combination with parent vessel occlusion is a useful technique with acceptable frequencies of morbidity and mortality for complex MCA aneurysms when conventional surgical or endovascular techniques are not feasible. The location of the aneurysm should be considered when planning the type of bypass and the site of vessel occlusion. Flow alteration by partial trapping may be preferable to total trapping for the M1<\/jats:sub> aneurysms.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2013.10.jns13738","type":"journal-article","created":{"date-parts":[[2013,11,29]],"date-time":"2013-11-29T08:34:52Z","timestamp":1385714092000},"page":"398-408","source":"Crossref","is-referenced-by-count":73,"title":["Bypass surgery for complex middle cerebral artery aneurysms: impact of the exact location in the MCA tree"],"prefix":"10.3171","volume":"120","author":[{"given":"Leena","family":"Kivipelto","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mika","family":"Niemel\u00e4","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; 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