Microsurgical management of middle cerebral artery aneurysms (72 cases reports)

Abstract

Objective To investigate the clinical features of middle cerebral artery aneurysms (MCAAs) and effects of microsurgical management. Method Seventy two patients with 75 MCAAs underwent microsurgical treatment between January 2007 and January 2009 were analyzed retropectively. There were 10aneurysms in M1 segment, 61 MCA bifurcation and 4 distal portion. Sixty-six patients presented with subarachnoid hemorrhage(SAH), of which 23 cases were associated with intracerebral hematoma. According to Hunt-Hess classification, 6 cases were grade 0, 6 gradeI, 28 grade Ⅱ, 18 grade Ⅲ, 9 grade Ⅳ and 5 grade V. All patients were underwent aneurysm clipping or wrapping microsurgically through pterional approach.Microvascular Doppler was applied intraoperatively to detect the blood flow of MCA and related branches.Results A total of 68 cases were operated successfully by surgical clipping, 4 cases by clipping plus wrapping. Fifty-two patiens(72%) had good recovery and 4 died (6%). Follow up ranged from 3 to 24months, good recovery was achieved in 62 cases(86%), severe disability in 4 (6%) and vegetative state in 2 (3%). There was no recurrence or rebleeding. Conclusions Sufficient preoperative evaluation and suitable operative approach are the key for successful management of MCAAs. Damage of MCA branches should be avoided to decrease the occurrence of post-operative cerebral infarction. Key words: Intracranial aneurysm; Middle cerebral artery; Microsurgery