title: Intraoperative Functional and Perfusion Monitoring During Surgery for Giant Serpentine Middle Cerebral Artery Aneurysms.
abstract: BACKGROUND
  Giant serpentine aneurysms are a rare entity, which can be managed using either endovascular or surgical techniques. Although the perioperative morbidity and mortality have decreased since the development of bypass revascularization procedures, their surgical treatment is still challenging. Intraoperative functional and perfusion monitoring techniques can be precious to make better decisions and improve outcomes.
  
  
  METHODS
  We report on the case of a giant, unruptured, partially thrombosed, serpentine middle cerebral artery aneurysm that was treated with partial endovascular coiling of intra-aneurysmal vascular channels, surgical resection of the aneurysm, and end-to-end M1-temporal M2 anastomosis.
  
  
  CONCLUSIONS
  Intraoperative continuous motor evoked potentials monitoring, flowmetry, and indocyanine-green angiography provide precise and reproducible information about cerebral function and perfusion, respectively, allowing for more rational decision making during surgery for these challenging malformations.
authors: Department of Neurosurgery, NOCSAE Modena Hospital, Modena, Italy.
authors: Giacomo
authors: G
authors: Pavesi
authors: Department of Neurosurgery, NOCSAE Modena Hospital, Modena, Italy.
authors: Stavros
authors: S
authors: Dimitriadis
authors: Department of Anesthesiology, NOCSAE Modena Hospital, Modena, Italy.
authors: Stefano
authors: S
authors: Baroni
authors: Department of Neuroradiology, NOCSAE Modena Hospital, Modena, Italy.
authors: Stefano
authors: S
authors: Vallone
authors: Department of Neurology, NOCSAE Modena Hospital, Modena, Italy.
authors: Franco
authors: F
authors: Valzania
authors: Department of Neurosurgery, NOCSAE Modena Hospital, Modena, Italy.
authors: Giovanni Battista
authors: GB
authors: Costella
authors: Department of Neurosurgery, NOCSAE Modena Hospital, Modena, Italy. Electronic address: alberto.feletti@gmail.com.
authors: Alberto
authors: A
authors: Feletti
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000098:blood supply*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D003131:Combined Modality Therapy; D003661:Decision Support Techniques; D004621:Embolization, Therapeutic; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D002532:Intracranial Aneurysm / Q000503:physiopathology / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D020768:Middle Cerebral Artery / Q000503:physiopathology / Q000601:surgery*; D016343:Monitoring, Intraoperative; D012039:Regional Blood Flow / Q000502:physiology; D012212:Rheology; D013699:Temporal Arteries / Q000601:surgery*; D014057:Tomography, X-Ray Computed
chemical_list: D007208:Indocyanine Green
keywords: Cerebral revascularization; Giant aneurysm; Indocyanine-green; Microvascular bypass; Motor-evoked potentials monitoring; Serpentine aneurysm; Ultrasound flowmetry