Journal of cerebrovascular and endovascular neurosurgery最新文献

{"title":"Clinical management of ruptured intracranial aneurysms in sickle cell disease patients.","authors":"Ahmet Hamit Çınkı, Mehmet Özer","doi":"10.7461/jcen.2026.E2026.03.005","DOIUrl":"https://doi.org/10.7461/jcen.2026.E2026.03.005","url":null,"abstract":"<p><strong>Objective: </strong>Sickle cell disease (SCD) is a hereditary hemoglobinopathy associated with various cerebrovascular complications. Although ischemic stroke is the most common manifestation, subarachnoid hemorrhage (SAH) secondary to ruptured intracranial aneurysms represents a rare but life-threatening condition in this population. Data regarding the optimal management of aneurysmal SAH in SCD patients remain limited.</p><p><strong>Methods: </strong>We retrospectively analyzed eight patients with confirmed SCD who were diagnosed with aneurysmal SAH and treated at a tertiary referral center. Clinical severity was assessed using the Glasgow Coma Scale (GCS), World Federation of Neurosurgical Societies (WFNS) grade, Hunt-Hess grade, and Fisher score. Aneurysm characteristics, including size, location, and multiplicity, were recorded. All patients underwent endovascular coil embolization. Hematologic parameters and peri-procedural multidisciplinary management strategies were reviewed. Aneurysm occlusion status was evaluated using the Raymond-Roy Occlusion Classification (RROC) at 6-month follow-up.</p><p><strong>Results: </strong>A total of 11 aneurysms were identified in 8 patients (mean age: 34.5 years; 5 males, 3 females). Three patients (37.5%) had multiple aneurysms. Six aneurysms (54.5%) were located in the anterior circulation and five (45.5%) in the posterior circulation. Four patients (50%) developed clinical and radiological vasospasm requiring intra-arterial therapy. All aneurysms were successfully treated with endovascular coiling. At discharge, modified Rankin Scale (mRS) scores ranged from 0 to 6. At 6-month follow-up, complete occlusion (RROC Class I) was achieved in the majority of treated aneurysms. Multidisciplinary perioperative management, including hematology consultation and transfusion strategies, was applied in all cases.</p><p><strong>Conclusions: </strong>Ruptured intracranial aneurysms in patients with SCD require careful multidisciplinary management due to disease-specific hematologic and vascular risks. Endovascular coil embolization appears to be a safe and effective treatment modality in this population. Early aneurysm securing combined with optimized hematologic management may improve clinical outcomes and reduce procedure-related complications.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angular morphometric factors associated with intraoperative rupture in anterior communicating artery aneurysms: A prospective observational study.","authors":"Vemula Venkata Ramesh Chandra, Sree Datta Pradeep Kundum, Kanduri Prithvi, Bodagala Vijayalakshmi Devi, Yangannagari Praveen, Bodapati Chandra Mowliswara Prasad, Thota Silpa, Aparna Rajeshwar Bitla","doi":"10.7461/jcen.2026.E2026.02.002","DOIUrl":"https://doi.org/10.7461/jcen.2026.E2026.02.002","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between angular morphometric parameters of anterior communicating artery (AComA) aneurysms and intraoperative rupture, and to assess the relationship of inflammatory biomarkers (high-sensitivity C-reactive protein (hs-CRP), homocysteine) with aneurysm wall inflammation.</p><p><strong>Methods: </strong>In this prospective observational study, 37 patients with AComA aneurysms undergoing microsurgical clipping (Jan 2023-Dec 2025) were included. All presented with aneurysmal subarachnoid hemorrhage (Fisher Grade ≥1). Morphometric parameters-aneurysm size, aspect ratio, size ratio, height-width ratio, vessel angle, flow angle, parent vessel angle, and inclination angle-were measured using computed tomography (CT) angiography and intraoperative microscopy. Aneurysm inflammation was defined by macroscopic features (wall thickening, discoloration, adhesions, friability). Preoperative hs-CRP and homocysteine levels were recorded. Patients were categorized into intraoperative rupture (n=13) and unruptured (n=24) groups. Statistical analysis used SPSS v26.0 (p≤0.05).</p><p><strong>Results: </strong>Vessel angle (74.76±15.9 vs. 56.8±25.8; p=0.03) and flow angle (153.24±15.3 vs. 137.58±22.4; p=0.035) were significantly higher in ruptured cases. Parent vessel angle was higher in unruptured aneurysms (121.88±33.4 vs. 98.85±10.2; p=0.02). hs-CRP (68.86±57.3 vs. 30.86±49.8; p=0.032) and homocysteine (12.47±5.2 vs. 9.38±3.4; p=0.041) were elevated in inflamed aneurysms but showed no association with intraoperative rupture.</p><p><strong>Conclusions: </strong>Vessel, flow, and parent vessel angles are significantly associated with intraoperative rupture risk. While hs-CRP and homocysteine reflect aneurysm inflammation, they do not predict intraoperative rupture. CT Angiography (CTA)-based morphometric parameters may assist in surgical risk stratification.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carotid cavernous fistula in Sturge-Weber syndrome: A unique case and literature review of associated vascular malformations.","authors":"Hector R Martinez, Emiliano Barajas de Leon, Alfonso Jose Castillo-Ivon, Paola Itzel Velediaz-Duran, Daniela Ayala-Victoria, Jose Alberto Moran-Guerrero, Nerea Martin Del Campo, Guillermo K Pons-Monnier, Jose Antonio Infante-Cantu, Beatriz Perez-Martinez, Oscar Gutierrez-Trevino, Sofia Lucila Rodriguez-Rivera, Jose A Figueroa-Sanchez","doi":"10.7461/jcen.2026.E2025.11.004","DOIUrl":"https://doi.org/10.7461/jcen.2026.E2025.11.004","url":null,"abstract":"<p><p>Sturge-Weber syndrome (SWS) is a neurocutaneous disorder associated with various intracranial abnormalities, such as leptomeningeal angiomatosis, the characteristic facial port wine stain (PWS), among others. However, several non-classic ones, such as non-traumatic carotid cavernous fistulas (CCF), represent not only life-threatening but commonly unrecognized abnormalities, posing a significant risk to these patients.</p><p><strong>Objective: </strong>We present a comprehensive analysis of current literature to describe vascular anomalies associated with SWS and present a case of a CCF in a patient with SWS.</p><p><strong>Methods: </strong>A case with an unusual concurrent finding of CCF and SWS is presented following CARE guidelines. Additionally, we conducted a literature review using MEDLINE, Scopus, and Web of Science databases focusing exclusively on vascular anomalies associated with SWS.</p><p><strong>Results: </strong>Our review identified 243 cases describing vascular anomalies in patients with SWS, with a minor number of cases describing a cavernous sinus anomaly.</p><p><strong>Conclusions: </strong>The co-occurrence of SWS and CCF appears to be underreported. Although SWS is associated with multiple vascular anomalies, current evidence supports a predisposing vascular environment rather than a direct causal relationship with CCF. Although other vascular anomalies are significantly associated with SWS, there is still a research gap with ample area of opportunity to define their clinical impact and the most appropriate management.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tenzingplasty for symptomatic, non-occlusive intracranial atherosclerotic disease after maximal medical therapy failure.","authors":"Faraz Behzadi, Cameron M McDougall, Neehar Gaddam, Judy Dawod, Ekokobe Fonkem, Andrei V Alexandrov, Nikhil K Mehta","doi":"10.7461/jcen.2026.E2025.11.003","DOIUrl":"https://doi.org/10.7461/jcen.2026.E2025.11.003","url":null,"abstract":"<p><strong>Objective: </strong>Intracranial atherosclerotic disease (ICAD) is an important cause of ischemic stroke. Balloon angioplasty for ICAD with or without a stent is associated with a high complication rate. The Tenzing support catheter (Route92 Medical) is a tapering offset catheter designed for improving aspiration catheter delivery in large vessel occlusion ischemic stroke (LVO). In LVO secondary to ICAD, we noted that the Tenzing could be used for angioplasty. In this study, we report our experience with the Tenzing angioplasty technique (T-Plasty) for ICAD treatment in the absence of LVO.</p><p><strong>Methods: </strong>A prospectively maintained database of all adult ICAD patients without LVO treated with T-Plasty at our institution was reviewed. Information on demographics, procedural details, clinical outcomes, and complications is reported here based on the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Student's T-test was applied to evaluate for statistical significance when appropriate.</p><p><strong>Results: </strong>From September 2024 to April 2025, 18 adult patients underwent T-Plasty for symptomatic ICAD without LVO. All patients experienced an improvement; the early cohort had a 4.5 points reduction in NIHSS immediate post T-Plasty, and both the elective and early cohorts experienced close to 1 point improvement in baseline mRS. No operative or post-operative related complications were noted up to 30-day follow-up.</p><p><strong>Conclusions: </strong>T-Plasty for the elective treatment of chronic symptomatic ICAD and acute hypoperfusion syndrome is an option for improving neurologic outcome.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-overlapping Y-stent configuration flow diverter placement in a complex anterior cerebral artery bifurcation aneurysm.","authors":"Megan Finnerann, Ajeet Gordhan","doi":"10.7461/jcen.2025.E2025.05.006","DOIUrl":"10.7461/jcen.2025.E2025.05.006","url":null,"abstract":"<p><p>Y-configuration stent deployment strategies for aneurysms with complex configurationare well recognized, with and without subsequent coil placement. Delivery of flow diverters in this configuration has no precedent in the literature and may be a viable alternative when feasible. A case is presented in which this configuration for a complex anterior cerebral artery aneurysm was achieved, with subsequent successful aneurysm closure.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"70-76"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microsurgical treatment of saccular basilar artery trunk aneurysms: Results and case illustrations.","authors":"Revaz Dzhindzhikhadze, Vadim Gadzhiagaev, Andrey Polyakov, Ruslan Sultanov, Abdulla Abdullaev, Andrey Zaytsev","doi":"10.7461/jcen.2025.E2025.03.005","DOIUrl":"10.7461/jcen.2025.E2025.03.005","url":null,"abstract":"<p><strong>Objective: </strong>Saccular aneurysms of the basilar artery (BA) trunk are a significant challenge in neurosurgery due to their rarity and the complexity of surgical approaches. This study examines the efficacy and outcomes of microsurgical treatment for these aneurysms, highlighting the advantages over endovascular methods in terms of occlusion rates and complication management.</p><p><strong>Methods: </strong>A retrospective review of 23 patients with BA trunk aneurysms treated microsurgically at the Moscow Regional Clinical Research Institute from June 2019 to April 2024 was conducted. Patient demographics, aneurysm characteristics, surgical techniques, and postoperative outcomes were analyzed.</p><p><strong>Results: </strong>The study group included 16 women and 7 men, with an average age of 51.2 years. Notably, 19 of 23 patients (82.6%) presented with subarachnoid hemorrhage (SAH), while 4 had unruptured aneurysms (2 asymptomatic, 2 with mass effect). Aneurysms were predominantly located at the origin of the superior cerebellar artery (SCA). Surgical approaches varied based on aneurysm location, with most utilizing the orbito-pterional approach. Complete occlusion was achieved in all cases and was maintained over the follow-up period without signs of recanalization. Complications included transient oculomotor nerve dysfunction in 5 patients, with a substantial recovery rate. Favorable outcomes (mRS 0-2) were achieved in 87% of patients, including most SAH cases, highlighting the safety and effectiveness of treatment.</p><p><strong>Conclusions: </strong>Microsurgical treatment of BA trunk aneurysms provides a reliable occlusion with a low rate of complications and excellent clinical outcomes. This series supports microsurgery as a preferred option for managing these challenging aneurysms, particularly when located at the SCA origin.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"10-23"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous and simultaneous bilateral middle meningeal arteriovenous fistula: A case report.","authors":"Gi-Yong Yun, Jae-Min Ahn, Jong-Hyun Park, Hyuk-Jin Oh, Jai-Joon Shim, Seok-Mann Yoon","doi":"10.7461/jcen.2025.E2024.04.001","DOIUrl":"10.7461/jcen.2025.E2024.04.001","url":null,"abstract":"<p><p>Middle meningeal arteriovenous fistulas (MMAVFs) are known as rare diseases, often associated with head trauma, with idiopathic cases being exceedingly uncommon. Here, we present a clinical case of spontaneous and simultaneous bilateral MMAVFs in a 37-year-old woman. She presented with persistent pulsatile tinnitus but no history of head trauma. Bilateral MMAVFs were identified via Time-of-Flight Magnetic Resonance Angiography. Subsequent digital subtraction angiography revealed a fistula between the middle meningeal artery (MMA) and middle meningeal vein (MMV) without definite intracranial venous reflux. We had planned coil embolization via a trans-arterial approach for both sides. Remarkably, after six days, the right-sided MMAVF observed in the previous external carotid artery (ECA) angiogram disappeared spontaneously. The left-sided MMAVF was successfully treated with coil embolization, achieving complete obliteration of fistula flow. Postoperatively, the patient's pulsatile tinnitus disappeared, and she was discharged without medication. There are a few possible mechanisms of spontaneous MMAVFs, such as middle meningeal artery aneurysm and trivial head trauma. Trans-arterial embolization with coils appears to be an effective and safe treatment option for complete obliteration of fistula flow.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"49-56"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of cranioplasty with customized artificial bone flap made by 3D printing technique in patients with aneurysmal subarachnoid hemorrhage.","authors":"Min Geun Gil, Sung-Tae Kim, Se Young Pyo, Juwhan Lee, Jin Lee, Won Hee Lee, Keun Soo Lee, Sung-Chul Jin, Sung Hwa Paeng, Moo Seong Kim, Young Gyun Jeong","doi":"10.7461/jcen.2025.E2025.09.003","DOIUrl":"10.7461/jcen.2025.E2025.09.003","url":null,"abstract":"<p><strong>Objective: </strong>This study compared clinical and cosmetic outcomes of cranioplasty using customized three-dimensional (3-D) printed implants versus autologous bone in patients with aneurysmal subarachnoid hemorrhage (aSAH) after decompressive craniectomy (DC).</p><p><strong>Methods: </strong>We retrospectively reviewed 50 patients who underwent cranioplasty after DC for aSAH between July 2018 and December 2023. Patients were divided into the three-dimensional cranioplasty(3-DC, n=26) and autologous bone cranioplasty (AC, n=24) groups. Demographics, aneurysm characteristics, surgical parameters, morphometric analysis of defect coverage, complications, and functional outcomes assessed by the modified Rankin Scale (mRS) were compared.</p><p><strong>Results: </strong>A total of 54 hemispheres underwent cranioplasty. Compared with AC, the 3-DC group had larger defects but achieved higher coverage (96.7% vs. 93.4%, p=0.044) and smaller residual defects (338.7±274.2 mm² vs. 528.5±331.3 mm², p=0.049). Complication rates were lower in 3-DC (9 cases) than AC (15 cases, p=0.0994). Wound dehiscence and fluid collection were more frequent with 3-DC, while bone flap resorption and epidural abscess occurred only with AC. Revision surgery was required in six patients, five initially treated with autologous bone. Neurological outcomes (mRS) were maintained or improved in both groups.</p><p><strong>Conclusions: </strong>In aSAH patients undergoing cranioplasty after DC, customized 3-D printed implants achieved significantly better anatomical restoration and showed a numerical trend toward fewer complications compared with autologous bone. While AC remains feasible, its risks of resorption and infection often necessitate revision. 3-D printed implants may be considered a reasonable alternative, particularly in aSAH patients at higher risk of complications.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"35-48"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment outcome of flow-diversion with Surpass Evolve stent for unruptured intracranial aneurysms: Predictors of poor occlusion.","authors":"Jiyeong Kim, Jai Ho Choi, Yong Sam Shin, Woo Cheul Cho","doi":"10.7461/jcen.2025.E2025.08.004","DOIUrl":"10.7461/jcen.2025.E2025.08.004","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to investigate the predictors of aneurysm occlusion following flow diversion treatment for unruptured intracranial aneurysms (UIA) using the Surpass Evolve (SE) stent.</p><p><strong>Methods: </strong>The radiological and clinical outcomes of UIAs treated using SE stent at a single tertiary hospital were reviewed retrospectively. We categorized radiological outcome into the poor (O'Kelly-Marotta [OKM] grade A-B) and favorable occlusion group (OKM grade C-D). Univariate and multivariate analyses were conducted to identify risk factors associated with poor occlusion.</p><p><strong>Results: </strong>A total of 68 unruptured intracranial aneurysms in 52 patients were treated in our institution from December 2019 to July 2024. At last radiological follow-up (mean 17.5±10.1 months), the overall favorable occlusion rate was 79.4% (n=52). Multivariate analysis showed larger aneurysm (p=0.011, OR=0.89, 95% CI [0.81-0.98]) and presence of incorporated branch (p=0.007, OR=8.26, 95% CI [1.78-38.28]) were associated with independent factors for poor occlusion, respectively. Procedural mortality and morbidity were 0% (n=0) and 1.9% (n=1). One patient presented with delayed ischemic stroke (1.9%, n=1) without permanent neurological deficit.</p><p><strong>Conclusions: </strong>Treatment for UIAs using the Surpass Evolve flow-diverting stent might be feasible for efficacy and safety. In this study, larger size of aneurysm and branch incorporated aneurysm were associated with poor occlusion after flow-diversion using SE stent.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"24-34"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parent artery encroachment after clipping of kissing middle cerebral artery bifurcation aneurysm: A case report.","authors":"Changheon Kim, HyoJun Kim, Taesik Song, Seung Kon Huh","doi":"10.7461/jcen.2025.E2025.08.002","DOIUrl":"10.7461/jcen.2025.E2025.08.002","url":null,"abstract":"<p><strong>Background: </strong>Kissing middle cerebral artery bifurcation aneurysms (KMCBA) are rare vascular lesions. Their complex morphology and limited surgical experience may predispose patients to devastating complications.</p><p><strong>Cases: </strong>Among 100 patients who underwent microsurgical clipping for cerebral aneurysms between May 2022 and April 2025, two were diagnosed with unruptured KMCBA. In Case 1, the two aneurysm sacs of a left KMCBA were clipped separately using interlocking and fenestrated clips without premature rupture. In Case 2, both aneurysm sacs of a right KMCBA were clipped simultaneously with a long J-shaped clip. Postoperatively, the patient developed left hemiparesis due to clip-induced encroachment of the superior trunk of M2. Revision clipping with a shorter L-shaped clip restored flow, and the patient was discharged with a modified Rankin scale (mRS) score of 4.</p><p><strong>Conclusions: </strong>Successful microsurgical clipping of KMCBA requires meticulous surgical strategies to avoid parent artery encroachment, including separate clipping of each aneurysm neck whenever feasible, appropriate clip selection, and the use of multimodal intraoperative anatomical and physiological monitoring.</p>","PeriodicalId":94072,"journal":{"name":"Journal of cerebrovascular and endovascular neurosurgery","volume":" ","pages":"77-82"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}