Open Surgical Treatment of Middle Cerebral Artery Aneurysms: A Single-Center Series in the Endovascular Era

Abstract

ObjectiveWe review the outcomes of open surgical treatment of MCAAs at a single center, focusing on aneurysm obliteration rates and functional outcomes at the most recent follow-up. These findings can be used for future comparisons of surgical outcomes with MCAAs. MethodsWe retrospectively reviewed cases from a prospectively maintained database of patients receiving open surgical treatment for ruptured or unruptured MCAAs between July 2014 and December 2022. We utilized patients’ mRS score and GOS score as functional outcome measures. Means, standard deviations, medians, and interquartile ranges were calculated, and a student’s t-test or its non-parametric equivalent was used to compare subgroups. Results150 patients (114 women, 76%; mean age 55.0±14.7 years) with a total of 156 MCAAs comprised 152 cases; 85 (56%) ruptured and 71 (46%) unruptured. Bypass was performed in 34 cases (22.4%); 18 ruptured (51.4%) and 16 unruptured (48.6%). Intraoperative rupture occurred in 5 (5%) ruptured and 1 (2%) unruptured cases. 145 patients (95.4%) had aneurysm obliteration with initial surgery, with 98.4% of patients having complete occlusion at 40.2±65.5 weeks of follow-up. Intra-hospital mortality occurred in seven (6.9%) ruptured versus one (2.0%) unruptured case. 52 (51.5%) of the ruptured compared to 43 (86%) unruptured patients were discharged home, with the remaining patients requiring inpatient rehabilitation or long-term hospitalization. The ruptured group had a mean hospital stay of 18.4±10.5 days vs 5.7±6.0 days for unruptured. Length of stay, discharge mRS/GOS, and mRS at 4-6 weeks favored unruptured cases (p<0.0001-0.0336). Mean change in mRS from presentation to last follow-up favored ruptured cases (-0.7±1.2 vs. -0.04±1.2, p=0.0215). ConclusionOpen surgery remains a safe and definitive treatment option for MCAAs in the endovascular era.