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Updated: May 22, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Endovascular treatment of proximal superior middle cerebral artery aneurysms
Boris Lubicz1, Martina Pezzullo, Denis Brisbois
1Department of Neuroradiology, Erasme University Hospital, Brussels, Belgium. blubicz@ulb.ac.be
Introduction:
Aneurysms superiorly located on the proximal segment of the middle cerebral artery (PMCAA) are rare and challenging to treat. No information is available regarding their management by endovascular approach. The aim of this study was to report our experience with endovascular treatment (EVT) of PMCAA.
Methods:
A retrospective review of our prospectively maintained database identified all PMCAA treated in our institution. The clinical charts, procedural data, and angiographic results were reviewed.
Results:
From April 2004 to December 2011, 17 patients were identified including six who presented with subarachnoid hemorrhage (SAH) and 11 with an unruptured PMCAA. All aneurysms were small (<6 mm) and had a branch arising from the neck or the sac, and 15/17 were wide-necked. All patients were successfully treated by balloon-assisted coiling (n = 10), stent-assisted coiling (n = 5), and coiling (n = 2). No technical or clinical complication occurred. Fifteen patients showed an excellent clinical outcome, and two kept a slight or a significant deficit that were both SAH-related. Immediate anatomical outcome includes nine complete occlusions and eight neck remnants. Imaging follow-up in 11 patients (mean = 21, range, 6 to 60 months) showed stable or improved results in all cases.
Conclusion:
Our study is the first reported series of patients with PMCAA treated by selective embolization. It suggests that EVT is a safe and effective alternative to surgery for the management of PMCAA. Balloon- or stent-assisted coiling are needed in most cases because of PMCAA morphological characteristics.
Insights
Proximal middle cerebral artery aneurysms (PMCAA) are rare. Endovascular treatment (EVT) using balloon- or stent-assisted coiling offers a safe and effective alternative to surgery for these challenging cases.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Proximal middle cerebral artery aneurysms (PMCAA) are uncommon and pose significant treatment challenges.
- Limited data exists on the endovascular management of PMCAA.
Purpose of the Study:
- To evaluate the safety and efficacy of endovascular treatment (EVT) for PMCAA.
- To report institutional experience with EVT for PMCAA.
Main Methods:
- Retrospective review of prospectively maintained database for PMCAA cases treated between April 2004 and December 2011.
- Analysis of clinical data, procedural details, and angiographic outcomes.
Main Results:
- 17 patients with PMCAA (6 with subarachnoid hemorrhage, 11 unruptured) were treated.
- All aneurysms were small (<6 mm), often wide-necked, with branches arising from the neck or sac.
- Successful EVT achieved using balloon-assisted coiling (10), stent-assisted coiling (5), or coiling (2) with no complications. Excellent clinical outcomes in 15 patients.
Conclusions:
- EVT is a safe and effective alternative to surgical treatment for PMCAA.
- Balloon- or stent-assisted coiling techniques are frequently necessary due to PMCAA morphology.
- This study represents the first reported series on selective embolization for PMCAA.
