Related Experiment Video
Updated: Aug 17, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
[Endovascular treatment of unruptured middle cerebral artery aneurysms]
J R Vanzin1, C Mounayer, M Piotin
1Departement de Neuroradiologie Interventionelle, Fondation Ophtalmologique Rothschild, 25 rue Manin, 75019 Paris. josericardovanzin@hotmail.com
Introduction:
Middle cerebral artery aneurysms (MCA) often present an unusual anatomical feature for the endovascular treatment and are frequently sent to surgery. We report our experience in the endovascular treatment of unruptured MCA aneurysms and compare it with results from the neurosurgical literature.
Patients And Methods:
In this retrospective study were included all patients with unruptured MCA aneurysms treated in our institution between November 1998 and December 2003. 3D imaging was performed in all cases to determine precisely the relationship between aneurysm and parent artery. The degree of occlusion of the aneurysms was estimated according to Raymond's classification. The neurological state was evaluated according to the Rankin scale and was re-evaluated at the time of each follow-up.
Results:
Eighty four patients with 100 aneurysms were analysed. Ninety aneurysms were treated by endovascular approach. Nine aneurysms were sent to surgery, after 3D imaging analyses or failed endovascular treatment. In one patient, related to the aneurysm configuration, a conservative attitude has been adopted. Four giant aneurysms were treated by parent vessel occlusion and 86 aneurysms were selectively occluded. The remodelling technique with balloon was performed in 58.1% of cases. Eight patients presented a new neurological deficit. The deficit was transient in six cases, and permanent in 2 cases. There was no mortality in this series. In 86 aneurysms selectively treated, there were 87.2% good results (grades A and B). Seventy one aneurysms (82.5%) treated were controlled between 3 and 58 months with a 19.6 months average. Recurrences were observed in 25.3% of cases. They were major in 9.8% and retreatment was performed.
Conclusion:
We report the feasibility of the endovascular treatment of MCA aneurysms previously estimated untreatable. Per procedural 3D imaging and remodelling technique were fundamental tools in the management of these aneurysms.
Insights
Endovascular treatment is feasible for complex middle cerebral artery (MCA) aneurysms. Advanced imaging and balloon remodelling techniques were crucial for successful outcomes in treating these challenging MCA aneurysms.
Area of Science:
- Neurosurgery
- Endovascular Therapy
- Cerebrovascular Diseases
Context:
- Middle cerebral artery (MCA) aneurysms often pose anatomical challenges for endovascular treatment.
- Many MCA aneurysms are traditionally managed surgically.
- This study evaluates endovascular treatment for unruptured MCA aneurysms.
Purpose:
- To report the experience and outcomes of endovascular treatment for unruptured MCA aneurysms.
- To compare endovascular results with neurosurgical literature.
- To assess the feasibility of endovascular approaches for previously untreatable MCA aneurysms.
Summary:
- Eighty-four patients with 100 unruptured MCA aneurysms were analyzed; 90 were treated endovascularly.
- The remodelling technique with balloon was used in 58.1% of cases.
- Good results (grades A and B) were achieved in 87.2% of selectively treated aneurysms, with a 19.6-month average follow-up.
Impact:
- Endovascular treatment is a feasible option for complex MCA aneurysms.
- Periprocedural 3D imaging and balloon remodelling are essential tools.
- This approach offers a viable alternative to surgery for select MCA aneurysms.
