title: Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery.
abstract: OBJECTIVE
  In recent years the endovascular treatment of intracranial aneurysms (coiling) has progressively gained recognition, particularly after the publication of the International Subarachnoid Aneurysm Trial (ISAT) in 2002. Despite the fact that in ISAT middle cerebral artery (MCA) aneurysms were clearly underrepresented, the study is often used as an argument to favor coiling above surgery in MCA aneurysms. Taken into account that MCA aneurysms are very well accessible for surgery, a contemporary assessment of the benefits of a preferred surgical strategy for MCA aneurysms was performed in a tertiary neurovascular referral center.
  
  
  METHODS
  A prospectively kept single-center database of 151 consecutive patients with an MCA aneurysm was reviewed over a 6-year period (2001-2006). Long-term follow-up after surgical treatment of a ruptured MCA aneurysm was obtained in 74 out of 77 (96%) patients. The outcome was compared with relevant series in the literature.
  
  
  RESULTS
  After a mean follow-up of 4.7 years, 59 out of 74 surgically treated patients (80%) with a ruptured MCA aneurysm had a good outcome (mRankin 0-2). All patients with an unruptured MCA aneurysm also had a good outcome after clipping. This is well-matched with the findings of the literature search, and competitive with the endovascular results.
  
  
  CONCLUSIONS
  Surgical clipping is recommended as the principal treatment strategy for MCA aneurysms. This is not only ethically defendable in view of the surgical results but also in line with a strategy to maintain surgical experience within centralized neurovascular centers.
authors: Department of Neurosurgery, University Medical Center Groningen, University of Groningen, The Netherlands. jmcvandijk@gmail.com
authors: J Marc C
authors: JM
authors: van Dijk
authors: Rob J M
authors: RJ
authors: Groen
authors: Mark
authors: M
authors: Ter Laan
authors: Johanna Rinck
authors: JR
authors: Jeltema
authors: Jan Jacob A
authors: JJ
authors: Mooij
authors: Jan D M
authors: JD
authors: Metzemaekers
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000592:standards*; D013995:Time; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality