Article
Surgical versus endovascular treatment of middle cerebral artery aneurysms: a single center series and systematic review
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Published: | May 13, 2014 |
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Outline
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Objective: Intracranial aneurysms of the middle cerebral artery (MCA) can be treated by surgical clipping or endovascular procedures. However, controversy exists regarding the best therapeutic strategy, both, in patients with ruptured and unruptured MCA aneurysms. We therefore performed a systematic review and analyzed surgical and endovascular results in ruptured and unruptured MCA aneurysms.
Method: Between 2005 and 2013, 194 aneurysms of the MCA were treated surgically or endovascularly in our institution. MEDLINE was searched for published studies of surgical and endovascular treatment of MCA aneurysms to gain a larger population. Two reviewers independently extracted data. Outcome measures were rate of complete aneurysm occlusion, reperfusion and retreatment.
Results: Literature data, including the current series revealed a total of 2741 MCA aneurysms in patients who underwent surgical or endovascular treatment. 1363 of 2741 (50%) MCA aneurysms were treated surgically, and 1378 MCA aneurysms (50%) were treated endovascularly. Total occlusion was achieved in 1331 MCA aneurysms treated surgically compared to 726 treated endovascularly (98% vs. 53%; p<0.0001). Reperfusion of the aneurysm occurred only in aneurysms treated endovascularly (0% vs. 13%; p<0.0001). Meta-analysis of the included studies revealed a significantly higher rate of complete occlusion in patients with MCA aneurysms who underwent surgical treatment.
Conclusions: The present data strongly indicates that surgical clipping of MCA aneurysms leads to significantly better initial occlusion rates and less aneurysm recurrence. Therefore clipping should be the treatment modality of choice in ruptured and unruptured MCA aneurysms.