Article
Surgical treatment of unruptured middle cerebral artery bifurcation aneurysms – long-term retrospective single-centre study
Mikrochirurgische Behandlung von unrupturierten Arteria cerebri media Bifurkationsaneurysmen – eine retrospektive monozentrische Langzeitstudie
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Published: | June 4, 2021 |
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Objective: Microsurgical clipping of middle cerebral artery aneurysms (MCA) has traditionally been regarded as a standard treatment. Recently, a caseload reduction related to improved endovascular treatment options has occurred in cerebrovascular neurosurgery. Therefore, studies reporting the clinical and radiological long-term outcomes after clipping are highly warranted.
Methods: Patients with an unruptured MCA bifurcation aneurysm, who were surgically treated between 2002-October 2019, were included. In each patient the surgical strategy and clinical as well as radiological outcome was retrospectively determined. Logistic regression analyses were conducted in order to identify possible effects of clinical and demographic variables on several main and secondary target criteria related to complication.
Results: Overall 272 consecutive patients were included (mean age at operation 55 years, range 18-79 years). 270 patients were successfully clipped (mean aneurysm diameter: 5.8mm, range 2-25mm; 1-8 clips per patient) with an additional wrapping performed in six patients. Complete aneurysm occlusion was demonstrated in 252 patients (92.7%) using postoperative digital subtraction angiography in 254 patients (93.4%). Intraoperative rupture occurred in eight patients. In six patients (2.2%) a permanent neurological deficit persisted after treatment. At the last follow up only two of these six patients had an unfavorable outcome (modified ranking scale 3-5). In logistic regression analysis a significant effect of intraoperative rupture (p=0.049) on a permanent neurological deficit was estimated. Further, the risk of neurological deficits decreased significantly over time meaning that patients who were operated at a later time point suffered less often from a permanent neurologic deficit (p=0.009). Two patients died (0.7%) perioperatively (fatal fulminant sepsis versus pulmonary embolism). Two patients were retreated approximately 6 and 14 years after initial clipping surgery, of whom one patient presented with subarachnoid hemorrhage.
Conclusion: In this long-term retrospective study the morbidity and mortality rates were estimated to be very low when microsurgical clipping was performed. Especially retreatment rates were found to be low. Therefore, mircrosurgical clipping remains an adequate treatment strategy in patients with unruptured MCA aneurysms.