Surgical management of middle cerebral artery aneurysms

Abstract

Background. The middle cerebral artery (MCA) harbors approximately 14% to 30% of all ruptured cerebral aneurysms. They can occur at multiple sites throughout the course of the middle cerebral artery, but most often are found at the bifurcation of the first segment (M1).
 Methods. A retrospective review of 116 consecutive patients with an MCA aneurysm treated by surgical clipping, by two senior neurosurgeons, was performed. The data of all our consecutive patients were searched to obtain patient characteristics, details of the aneurysm size and orientation, treatment details, complications and follow up. At admission, the clinical condition of all patients was classified according to the Hunt and Hess scale. Clinical outcome was graded according to the modified Rankin scale. The follow-up period varied widely from 2 to 72 months (mean 30 months).
 Results. Surgical clipping was performed for 113 ruptured MCA aneurysms; only in 3 cases the aneurysm was unruptured. Fourteen patients presented with significant hematoma which required the evacuation of the clot. Post-operative control angiography was performed in 32 patients (27.5%), from which we reported a full occlusion of the aneurysm in 32 patients (93.75%). Perioperative mortality was 5.2% (6 patients), due to neurological (4 patients) or systemic causes (2 patients). The outcome was graded mRankin 0–2 in 72.5% of the cases (84 patients) at the end of the first postoperative months, and 78.5% (91 patients) at six months follow-up. The most important improvement was recorded for patients graded mRankin 1-2 at the first month follow-up. All 3 patients with a surgically treated asymptomatic MCA aneurysm had an excellent outcome (mRS 0) at both follow-up, 1 months and respectively 6 months.
 Conclusions. For the experienced neurovascular team, MCA aneurysms currently make microsurgical treatment the preferred treatment modality for most MCA aneurysms.