Middle Cerebral Artery Aneurysms: A Single-Center Series Comparing Endovascular and Surgical Treatment

Treatment of middle cerebral artery (MCA) aneurysms: a review of the literature

“…Excellent outcomes can be achieved via a microsurgical approach when cases are carefully selected and planned. According to previous reports, good outcomes were reported in 70-100 % MCA aneurysm patients who underwent clipping, with 70-80 % for ruptured patients and 92-100 % for the unruptured cohort [1,15,16,24,30,34,47]. Aneurysm occlusion rates were reported to be 90-98.3 % [1,15].…”

“…The authors observed comparable results in poor outcomes for coiling (10.0 %) and clipping (5.9 %) with a slight advantage towards clipping. They also reported a 14.0 % retreatment rate for coiling group in comparison to none in the clipping group in a 9-month follow-up period [30]. Although no significant difference was observed for functional outcomes at follow-up, coiling was still associated with more procedural complications (16.0 versus 0.0 %) and higher retreatment rates.…”

“…In contrast to the treatment of most posterior circulation aneurysms where there is an evident advantage of endovascular compared to surgical approaches regarding ease of access and treatment outcomes, the selection of treatment for MCA aneurysms consistently favors microsurgical management [1,2,15,24,30,31]. The relatively superficial location of MCA aneurysms permits easy surgical access with minimal frontal or temporal lobe retraction, thereby resulting in excellent prognosis [1,15,16,[20][21][22][23][32][33][34][35].…”

“…In addition, as suggested by Rodriguez and authors [15], the distribution of aneurysm locations in the ISAT study is significantly different from what was previously reported, with MCA aneurysms comprising only 14.0 % of all aneurysms in ISAT as compared to approximately 25.0 % in reported literature, suggesting a potential sampling bias that favors maximizing outcome in the coiling group. Furthermore, current available comparative studies and meta-analyses on MCA aneurysm treatment suggested slight to moderate advantage of clipping over coiling [24,30,31,42]. Therefore, further investigation is warranted for justification of endovascular therapy as a viable alternative to surgical therapy in definitive treatment of MCA aneurysms.…”

Outcome for unruptured middle cerebral artery aneurysm treatment: surgical and endovascular approach in a single center

“…Regarding endovascular treatment of unruptured MCA aneurysms, a meta-analysis of 12 studies including 500 cases showed a procedure-related permanent morbidity and mortality of 5.1 % [4]. Smaller cohort studies show morbidity ranging between 1 and 20 % [1,6,12,13]. The three largest studies dating from 2009 to 2010 report "good outcomes" in 91-99 %, with a morbidity of 1-5 % and a mortality of 2 % [26,2,20].…”