Microsurgery for the treatment of complex middle cerebral artery aneurysms: a clinical analysis

Objectives To investigate the methods and efficacy of microsurgical treatment of complex middle cerebral artery (MCA) aneurysms. Method The clinical data of 32 patients with complex MCA aneurysm admitted to Tianjin Huanhu Hospital from January 2011 to January 2014 were analyzed retrospectively. The aneurysm diameter was 24.3 ± 6.3 mm. The aneurysms of 8 patients were located in the M1 segment of MCA (5 proximal aneurysms and 3 distal aneurysms), 15 at the MCA bifurcation, 9 at the M2 segment and distal end. Results The aneurysms of 15 patients were clipped directly, 6 had aneurysm resection of parent artery for remodeling, 2 had extra- and intra-cranial arterial bypass assisted aneurysm clipping, and 9 had extra- and intra-cranial arterial bypass and aneurysm trapping. Postoperative recovery was good (Glasgow outcome scale [GOS] Ⅳ-Ⅴ) in 25 cases (78.1%) and poor in 6 cases (18.8%). Five patients had good recovery at discharge, 1 had severe disability (GOS Ⅲ), and 1 died (3.1%). Twenty-five patients were followed up for 6 to 36 months (mean 18 months) and 6 were lost to follow up. None of the 25 patients had aneurysm rebleeding. The GOS score of 22 patients was Ⅴ, 2 was Ⅳ, and 1 was Ⅲ at the last follow-up. After procedure, DSA or CTA of 26 patients showed that the aneurysms of 21 patients disappeared completely, 4 had aneurysm partial residue (no further treatment), and 1 did not have obvious change after aneurysm trapping. The anastomotic vessels were patent in 11 patients treated with extra- and intra-cranial bypass and 4 treated with parent artery remodeling. Conclusion Direct surgical clipping is still an important means for the management of complex MCA aneurysms, and for those whose aneurysms can not be clipped directly, parent artery reconstruction or extra- and intra-cranial vascular bypass can be performed. The efficacy of microsurgery for the treatment of complex MCA aneurysms is good and its recurrence rate is low. Key words: Middle cerebral artery; Intracranial aneurysm; Microsurgery; Cerebral revascularization; Complex intracranial aneurysm