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Clipping first policy for middle cerebral artery aneurysm: A single-center cohort study

  • 0Department of Neurosurgery, Mohammed V University of Rabat, Faculty of Medicine and Pharmacy, Rabat, Morocco.
Surgical Neurology International +

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January 8, 2025

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January 8, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Microsurgical clipping offers excellent outcomes for middle cerebral artery aneurysms (MCAAs). A wider aneurysm neck and intracerebral hemorrhage at admission are linked to poorer prognoses for MCAA patients.

Area Of Science

  • Neurosurgery
  • Vascular Neurology
  • Medical Imaging

Background

  • Management of middle cerebral artery aneurysms (MCAAs) remains a subject of debate.
  • This study reviews a 40-year single-center experience with a "clipping first" policy for MCAAs.
  • Outcomes are compared based on aneurysm location.

Purpose Of The Study

  • To evaluate the clinical outcomes of a
  • clipping first
  • policy for MCAAs.
  • To compare short- and long-term outcomes based on MCAA location.

Main Methods

  • Retrospective cohort study of 968 aneurysm patients treated since 1983.
  • Focus on 279 MCAAs, with analysis of microsurgical clipping versus coiling.
  • Inclusion criteria: aneurysmal subarachnoid hemorrhage with WFNS Grade ≤III or ≥IV.

Main Results

  • 92.1% of MCAAs were microsurgically clipped, with 96.3% achieving good outcomes (mRS ≤2).
  • Poor outcomes (mRS >2) were significantly associated with higher intracerebral hemorrhage (ICH) at admission (mean 4.178 vs 0.827).
  • Wider MCAA neck/dome ratio correlated with poorer prognosis.

Conclusions

  • Microsurgical clipping demonstrates overwhelmingly good clinical outcomes for MCAAs.
  • Microsurgical treatment should be the primary consideration for MCAA management.
  • ICH at admission is a significant predictor of poor outcomes in MCAA patients.

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