title: Reconstruction options for complex middle cerebral artery aneurysms.
abstract: OBJECTIVE
  To describe techniques of reconstruction for unclippable and uncoilable middle cerebral artery aneurysms.
  
  
  METHODS
  A retrospective review was performed of seven patients who underwent eight operations during a 9-year period to treat complex middle cerebral artery bifurcation aneurysms not amenable to direct clipping or endovascular coiling. All preoperative and postoperative clinical and imaging data were reviewed. Follow-up was obtained for all patients via clinic visit and/or telephone.
  
  
  RESULTS
  The operative techniques used included saphenous vein graft bypass (n = 1), radial artery graft interposition (n = 2), radial artery patch (n = 1), superficial temporal artery interposition graft (n = 1), superior thyroid artery interposition graft (n = 1), direct reimplantation of branch (n = 1), and reconstruction of trifurcation (n = 1). There was no mortality. Six patients had excellent outcomes with Glasgow Outcome Scale scores of 5, and one patient had a good outcome with a Glasgow Outcome Scale score of 4.
  
  
  CONCLUSIONS
  Techniques for middle cerebral artery reconstruction may remain important and useful in the age of endovascular aneurysm treatment.
authors.affiliation: Department of Neurosurgery, North Shore University Hospital, Great Neck, New York 11021, USA. lsekhar@nshs.edu
authors.forename: Laligam N
authors.initials: LN
authors.lastname: Sekhar
authors.forename: Dinko
authors.initials: D
authors.lastname: Stimac
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Bakir
authors.forename: Ramin
authors.initials: R
authors.lastname: Rak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies