Aneurysm geometrics impact on microsurgical modality of ruptured and unruptured middle cerebral artery aneurysms

Abstract

Objective The aim of this study was to evaluate the influence of study of parent vessel and aneurysm geometry in modifying surgical therapeutic modalities of cerebral aneurysms. Background Saccular aneurysms are localized bulging of intracranial blood vessels. Imaging technologies have improved our understanding of the three-dimensional orientation of cerebral aneurysms. The localization, size, and morphology of middle cerebral artery (MCA) aneurysms are recognized as essential for the rupture risk prediction. Patients and methods Forty-one patients who underwent surgical treatment of at least one MCA aneurysm (nine patients in the ruptured group and 32 patients in the unruptured group) were analyzed for information on aneurysm morphology: shape, diameters, neck width, parent vessel diameter, location of the aneurysm [ first part of the MCA (M1) or the bifurcation segment], and the presence of branching vessels. Aneurysm occlusion and parent artery patency were assessed by intraoperative indocyanine green angiography. Postprocedural assessment included assessment of the patient's clinical condition and radiological follow-up. Results Forty-one aneurysms were clipped (100%) and nine aneurysms were wrapped and clipped (21%). The frequency of multilobulated aneurysms and aneurysms with bleb were significantly different in the subrachnoidal hemorrhage (SAH) group versus the non-SAH group. Branching vessels out of the aneurismal neck were registered and the frequency of aneurysms with the branch vessel was significantly different in the SAH versus the non-SAH group. Conclusion In MCA aneurysms, independent predictors for the risk of rupture and for the postsurgical outcome are the presence of SAH, location on the bifurcation segment, multilobulation, blebs, size, and finger-shaped aneurysm.