Abstract
Background and objectiveThe main challenge of bypass surgery of complex MCA aneurysms is not the selection of the bypass type but the initial decision-making of how to exclude the affected vessel segment from circulation. To this end, we have previously proposed a classification for complex MCA aneurysms based on the preoperative angiography. The current study aimed to validate this new classification and assess its diagnostic reliability using the giant aneurysm registry as an independent data set.MethodsWe reviewed the pretreatment neuroimaging of 51 patients with giant (> 2.5 cm) MCA aneurysms from 18 centers, prospectively entered into the international giant aneurysm registry. We classified the aneurysms according to our previously proposed Berlin classification for complex MCA aneurysms. To test for interrater diagnostic reliability, the data set was reviewed by four independent observers.ResultsWe were able to classify all 51 aneurysms according to the Berlin classification for complex MCA aneurysms. Eight percent of the aneurysm were classified as type 1a, 14% as type 1b, 14% as type 2a, 24% as type 2b, 33% as type 2c, and 8% as type 3. The interrater reliability was moderate with Fleiss’s Kappa of 0.419.ConclusionThe recently published Berlin classification for complex MCA aneurysms showed diagnostic reliability, independent of the observer when applied to the MCA aneurysms of the international giant aneurysm registry.
Highlights
Besides improvements in endovascular techniques and versatile clipping strategies, there are still some complex aneurysms—giant, fusiform, or partially thrombosed/calcified— with a need for vessel sacrifice after revascularization of the downstream vessel segment [10, 13, 14, 19, 23]
We retrospectively reviewed 51 cases with giant middle cerebral artery (MCA) aneurysms from 18 centers participating in the international giant aneurysm registry [4]
The data set provided by the members of the international giant aneurysm registry consisted of 51 patients with giant aneurysms of the MCA
Summary
Besides improvements in endovascular techniques and versatile clipping strategies, there are still some complex aneurysms—giant, fusiform, or partially thrombosed/calcified— with a need for vessel sacrifice after revascularization of the downstream vessel segment [10, 13, 14, 19, 23]. Complex aneurysms of the middle cerebral artery (MCA) are a special challenge. This is due to multiple perforators in the M1. For the preoperative planning of cerebral revascularization and aneurysm occlusion, it is of importance to anticipate the intraoperative anatomy. The main challenge of bypass surgery of complex MCA aneurysms is not the selection of the bypass type but the initial decision-making of how to exclude the affected vessel segment from circulation. To this end, we have previously proposed a classification for complex MCA aneurysms based on the preoperative angiography. The current study aimed to validate this new classification and assess its diagnostic reliability using the giant aneurysm registry as an independent data set
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