gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Surgical results in complex middle cerebral artery aneurysms not suitable for endovascular coiling

Meeting Abstract

  • Erdem Güresir - Abteilung für Neurochirurgie, Goethe Universität Frankfurt, Germany
  • Patrick Schuss - Abteilung für Neurochirurgie, Goethe Universität Frankfurt, Germany
  • Gerhard Marquardt - Abteilung für Neurochirurgie, Goethe Universität Frankfurt, Germany
  • Hartmut Vatter - Abteilung für Neurochirurgie, Goethe Universität Frankfurt, Germany
  • Volker Seifert - Abteilung für Neurochirurgie, Goethe Universität Frankfurt, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1663

DOI: 10.3205/10dgnc136, URN: urn:nbn:de:0183-10dgnc1367

Published: September 16, 2010

© 2010 Güresir et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: To assess the surgical results in complex middle cerebral artery (MCA) aneurysms deemed not suitable for endovascular coiling.

Methods: From 1999 to 2009 we treated 163 ruptured and 108 unruptured MCA aneurysms surgically as well as 59 aneurysms endovascularly. Patient and aneurysm specific characteristics were prospectively entered into our prospectively conducted database. The treatment decision was based on an interdisciplinary approach. All patients underwent diagnostic angiography before and after treatment. Aneurysms of large size and / or broad base, calcifications, and incorporation of M1 or M2 segments into the aneurysm base were defined as complex.

Results: 97.8% of the MCA aneurysms treated surgically and 76.3% treated endovascularly at least met one of the criteria for complexity mentioned above.

In MCA aneurysms treated surgically, complete occlusion was achieved in 264 of the 271 (97.4%) aneurysms. Mean size of aneurysm remnants was 2 ± 1.7 mm in 7 aneurysms (2.6%). Aneurysms with remnants after surgical treatment were significantly larger in size (17 ± 3 mm vs. 7 ± 5 mm), and exhibited significantly more often parent vessel involvement (M1: 86% vs. 27%; M2: 100% vs. 67%) compared to the group of aneurysms that could be treated without remnant.

Compared to our institutional data (52.5% complete occlusion rate) and data of the literature (up to 46.1% complete occlusion rate) the occlusion rates of endovascularly treated MCA aneurysms were significantly lower compared to MCA aneurysms treated surgically.

Conclusions: Surgical treatment of ruptured and unruptured MCA aneurysms results in a significantly higher rate of complete aneurysm occlusion compared to endovascular treatment, despite a high rate of complex aneuryms in the surgically treated group.