Article
Morphological aspects of 151 operatively treated MCA aneurysms – Impact on surgical treatment strategy
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Authors
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K. Steib
- Klinik für Neurochirurgie, Universitätsklinikum Regensburg
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M. Proescholdt
- Klinik für Neurochirurgie, Universitätsklinikum Regensburg
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A. Brawanski
- Klinik für Neurochirurgie, Universitätsklinikum Regensburg
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K.M. Schebesch
- Klinik für Neurochirurgie, Universitätsklinikum Regensburg
| Published: | June 4, 2012 |
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Outline
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Objective: Treatment of MCA aneurysms, ruptured or innocent, is the domain of vascular neurosurgery. The surgical success is strongly depending on individual characteristics as age and general condition but is also due to morphological and anatomical aspects of the aneurysm and its parent artery. The preoperative identification of radiologically assessed features is most valuable in the context of planning the surgical strategy. In this retrospective analysis, we correlate pre- and inraoperative findings with the short-term outcome in 151 MCA aneurysms.
Methods: We reviewed the charts and preoperative angiograms and CT-scans of 151 consecutive patients that experienced surgical treatment of at least one MCA aneurysm in our department. 69 patients presented with subarachnoid hemorrhage (SAH). We analyzed and statistically correlated the preoperative neurological condition, aneurysm morphology (shape, diameter, calcification, thrombi, adherent and branching vessels, neck/dome ratio, parent vessel diameter), surgical strategy (temporary clip, surgery time, intraoperative rupture) and postoperative neurological outcome.
Results: Multilobular aneuryms and aneurysms with a larger dome-basis distance ruptured significantly more frequently intraoperatively (p=0.005, p=0.01 resp.). The temporary clipping time was significantly longer in calcified aneurysms and aneurysms with branching vessels (p=0.041, p=0.001 resp.). Patients with immediate postoperative ischemia and consecutive neurological deterioration more frequently had multilobulated aneurysms, a larger maximal aneurysm diameter, a larger dome-basis distance and a larger neck and parent vessel diameter (p=0.008, p=0.032, p=0.046, p=0.013 and p=0.002, resp.). However, there was no difference in immediate postoperative ischemia between patients with SAH and non-SAH patients.
Conclusions: In this large series of exclusively surgically treated MCA aneurysms, we clearly identified morphological features that may be helpful in planning the surgical strategy. Basically, preoperative imaging should focus on shape and structure of the aneurysm and on the morphology of the environment.
