[Microsurgical techniques of middle cerebral artery aneurysms]

To summarize the experience in surgical treatment for middle cerebral aneurysm (MCAA), and results and prognosis thereof.

The clinical data, including location, size, main presentations, and Hunt & Hess grade, of 55 consecutive MCAA patients were prospectively analyzed. The surgical outcome was evaluated by Glasgow Outcome Scale (GOS). Follow-up was conducted for 23 (11-19) months.

According to the Hunt & Hess classification, there were 9 cases in grade 0, 12 cases in grade I, 23 cases in grade II, 8 cases in grade III, 2 cases in grade IV, and 1 case in grade V at admission. Headache (42 cases), vomiting (22 cases), and hemiplegia (11 cases) were the top 3 common presentations. Pterional craniotomy was adopted in all cases. Proximal to distal lateral fissure approach was used in 23 cases, distal to proximal approach in 27 cases, and trans-hematoma approach in 5 cases. There were 45 cases treated by direct neck-clipping (clipping and resecting in 6 cases), 7 cases by parent artery reconstruction, and 3 cases by wrapping by muscle. The location of MCAA was at the bifurcation in 37 cases (37.2%), at proximal middle cerebral artery (MCA) in 13 cases (23.6%), and at distal MCA in 5 cases (9.1%). The largest diameter was 15.5 (3-70) mm. The main postoperative complications included hemiplegia (12 cases), aphasia (3 cases), and seizure (2 cases). Follow-up showed good recovery in 45 cases, moderate disability in 5, and severe disability in 5 according to GOS. There was no vegetative state, death, and recurrence.

With modern imaging techniques, perfect surgical plan, appropriate surgical approach, and careful microsurgical techniques, treatment of MCAA can be perfected and achieve satisfying outcome.