Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Microsurgical treatment of distal middle cerebral artery aneurysm: A single-center review

  • Taehoon Jang (Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine) ;
  • Sung-Tae Kim (Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine) ;
  • Jin Lee (Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine) ;
  • Won-Hee Lee (Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine) ;
  • Keun-Soo Lee (Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine) ;
  • Se-Young Pyo (Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine) ;
  • Junghae Ko (Department of Endocrinology, Haundae Paik Hospital, Inje University, School of Medicine) ;
  • Hangwoo Lee (Department of Neurosurgery, Busan St. Mary's Hospital) ;
  • Yeong Gyun Jeong (Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine)
  • Received : 2023.06.23
  • Accepted : 2023.08.16
  • Published : 2024.03.31
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Abstract

Objective: To review the characteristics of distal middle cerebral artery (MCA) aneurysm treated by microsurgery, the detailed surgical options, and the clinical result. Methods: We retrospectively reviewed cerebral aneurysm in the M2 and M3 segments of the MCA surgically treated between January 2015 and December 2022. The demographic data, aneurysm-related findings, type of surgical approach, surgical technique, and clinical outcomes of the enrolled patients were analyzed. Results: Sixteen distal MCA aneurysms were treated with microneurosurgery (incidence, 1.0%; female, 12; mean age, 58.1 years; ruptured, three). Twelve aneurysms were in the M2 segment (insular segment), two aneurysms at the M2-M3 junction, and two aneurysms in the M3 segment (opercular segment). Twelve aneurysms were saccular (average size, 4.9 mm; multiplicity, 50%; average aneurysms, 3.0; partially thrombosed, 1; sidewall aneurysm, 2). Three aneurysms were fusiform, of which two were ruptured. Of the ruptured aneurysms, one was a ruptured dissecting aneurysm. The trans-sylvian and trans-sulcal approaches were used in fourteen and two patients, respectively. Neck clipping, wrap clipping, and surgical trapping were performed in twelve, one, and one patient, respectively. Proximal occlusion was performed in one patient. Bypass technique was required in two patients (neck clipping and proximal occlusion). The modified Rankin Score was 6 in the two patients with ruptured aneurysms. The remaining patients did not show further neurological deterioration after microneurosurgery. Conclusions: Distal MCA aneurysms had a high incidence of being diagnosed with multiple other aneurysms and were relatively non-saccular.

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References

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