title: Treatment results for complex middle cerebral artery aneurysms. A prospective single-center series.
abstract: BACKGROUND
  The objective was to assess the surgical results in complex middle cerebral artery (MCA) aneurysms.
  
  
  METHODS
  From 1999 to 2009 the data of 330 patients with ruptured and unruptured MCA aneurysms were included into a prospective database. Degree of aneurysm occlusion and clinical outcomes were analysed after 271 surgical and 59 endovascular treatments assigned in an interdisciplinary approach. Aneurysms of large size and/or broad base, calcifications, and incorporation of M1 or M2 segments into the aneurysm base were defined as complex.
  
  
  RESULTS
  At least one of the criteria for complexity mentioned above was met in 97.8% of the MCA aneurysms that were treated surgically and in 76.3% that were treated endovascularly. In MCA aneurysms treated surgically, complete occlusion was achieved in 264 of the 271 (97.4%) aneurysms. Aneurysms with remnants after surgical treatment were significantly larger in size (17 ± 3 mm vs 7 ± 5 mm), and exhibited significantly more often parent vessel involvement (M1: 86% vs 27%; M2: 100% vs 67%) compared with the group of aneurysms that could be treated without remnant. Compared with our institutional data (52.5% complete occlusion rate) and data of the literature (up to 46.1% complete occlusion rate), the occlusion rates of endovascularly treated MCA aneurysms were significantly lower compared with MCA aneurysms treated surgically.
  
  
  CONCLUSIONS
  Surgical treatment of ruptured and unruptured MCA aneurysms results in a significantly higher rate of complete aneurysm occlusion compared with endovascular treatment, despite a high rate of complex aneuryms in the surgically treated group.
authors.affiliation: Department of Neurosurgery, Johann Wolfgang Goethe-University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany. Gueresir@em.uni-frankfurt.de
authors.forename: Erdem
authors.initials: E
authors.lastname: Güresir
authors.forename: Patrick
authors.initials: P
authors.lastname: Schuss
authors.forename: Joachim
authors.initials: J
authors.lastname: Berkefeld
authors.forename: Hartmut
authors.initials: H
authors.lastname: Vatter
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery*; D002114:Calcinosis / Q000175:diagnosis / Q000601:surgery; D003299:Cooperative Behavior; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000601:surgery; D013525:Surgical Instruments