478 Microsurgical Outcome of Unruptured Middle Cerebral Artery Aneurysms

Abstract

INTRODUCTION: Recently introduced endovascular techniques for treating middle cerebral aneurysms (MCA) has to achieve results superior to surgical outcomes before it becomes the established treatment modality. We present our surgical outcomes in 403 unruptured aneurysms. METHODS: Data of 403 MCAs were prospectively collected and retrospectively analyzed. Modified pterional approach with linear dural opening over the Sylvian fissure (Limited brain exposure) was used. Outcome evaluated with Modified Rankin scale (mRS at DC and one year. RESULTS: 403 unruptured MCA aneurysms were clipped in 354 pts. 48 aneurysms (42 pts) had a ruptured aneurysm of different location and were excluded from analysis leaving 355 aneurysms in 312 patients. M/F ratio-1/2.9 Average age-59.34+ 12.22 and median age-60.109 pts had clipping of single MCA aneurysm during surgery and 203 had multiple aneurysms. Location: MCA bifurcation = 227 (64%), M1 = 101 (28%), M2 = 27 (8%) MCA. Size: Giant = 3 (1%); Large = 32 (9%); Medium = 85 (24%); Small = 235(66%), Outcome- MRs 0-2 at DC = 90%. MRs 0-2 at 3mo-1 year = 98.5%; Mortality = 0.64 % (1- sepsis, comfort care; 1- Massive heart attack); Residual = 0.84% (3/355); Ischemic event - 0.96% (3/312) CONCLUSIONS: Recently introduced endovascular techniques for treating middle cerebral aneurysms (MCA) cannot be pushed to become an established modality before at least it matches the present excellent results achieved with microsurgery. Maybe the future should focus on the high level microsurgery.