Abstract:

Objective   To discuss the choice and effectiveness of treatment of middle cerebral artery aneurysms(MCAA). Methods   111 patients with a total of 114 MCAA from January 2005 to July 2011 who underwent surgical clipping and endovascular interventional therapy were retrospectively analyzed. Factors analyzed included the pre-operation grading， the aneurysm size and location， and the clinical outcomes. Results   The angiographic  follow-up of the surgical clipping group (88 patients with a total of 90 aneurysms) 15 days to 48 months (mean 12.7 months)after the operation showed that 89 aneurysms were completely clipped and the residual neck appeared in only 1 aneurysm. There was no angiographic recurrence in any the aneurysms. In the endovascular treatment group (23 patients with a total of 24 aneurysms), 7 ruptured aneurysms were treated with stent-assistance， 3 with balloonassistance， and 12 with coil only. The angiographic follow-up of the 17 aneurysms 1 month to 37 months (mean 10.6 months)after the operation showed that 5 recurred(29.4%). 2 un-ruptured dissecting aneurysms were treated with stent only. The angiographic follow-up 3 months after the operation showed that 1 aneurysm was completely occluded and the other stayed the same. Good outcome (Glasgow Outcome Score = 4-5) occurred in 81.8% (72 patients) in the clipping group and 91.3% (21 patients) in the endovascular treatment group. Conclusion   “Berrylike” MCAA is suitable for both surgical clipping and endovascular treatment. Lower recurrence was associated with surgical clipping in the complex MCAA, but higher recurrence was associated with endovascular treatment. Surgical clipping should be considered in MCAA with hematoma(volume of hematoma＞30mL)and the hematoma should be cleared. Both endovascular treatment and surgical clipping can effectively prevent MCAA rebleeding.

Key words: Middle cerebral artery； Aneurysm； Surgical clipping；   Endovascular treatment