Microsurgical Clipping of Unruptured Middle Cerebral Artery Bifurcation Aneurysms: Incidence of and Risk Factors for Procedure-Related Complications

Abstract

To report our experiences in microsurgical clipping of unruptured middle cerebral artery (MCA) bifurcation aneurysms and to evaluate the incidence of and risk factors for procedure-related complications. The study comprised 416 patients treated between March 2003 and February 2014. All patients met the following criteria: 1) microsurgical clipping of an unruptured MCA bifurcation aneurysm was performed, and 2) clinical and radiographic follow-up data were available including preoperative digital subtraction angiography. The incidence of and risk factors for procedure-related complications were retrospectively evaluated. Procedure-related complications occurred in 15 (3.6%) patients, including asymptomatic complications in 10 (2.4%) patients and symptomatic complications in 5 (1.2%) patients. Multivariate logistic regression analysis showed that posteroinferior projection of the aneurysm (odds ratio= 2.814, 95% confidence interval= 0.995-6.471, P=0.042), distance between the internal carotid artery bifurcation and the MCA bifurcation (Dt) in a linear line (odds ratio= 1.813, 95% confidence interval= 0.808-6.173, P= 0.043), and horizontal angle between the vertical line tothe base of the skull and Dt (odds ratio= 2.046, 95% confidence interval= 1.048-10.822, P= 0.048) were independent risk factors for procedure-related complications. When performing clipping of unruptured MCA bifurcation aneurysms, the procedure-related complication rate was 3.6%. Patients with MCA bifurcation aneurysms with posteroinferior projection, shorter Dt,and larger horizontal angle may be at a higher risk of procedure-related complications when performing microsurgical clipping.