title: Bilateral middle cerebral artery aneurysms: a comparative study of unilateral and bilateral approaches.
abstract: The best surgical method for the treatment of patients with bilateral middle cerebral artery (bMCA) aneurysms has not been fully determined yet. The main purpose of this study is to compare the surgical results of unilateral and bilateral approaches to bMCA aneurysms including mean operation time, mean hospital stay, and mean cost, in the experience of the same neurosurgical team. Between January 2001 and June 2010, 22 patients with bMCA aneurysms were surgically treated in our institution. In 12 cases (54.5 %), ipsilateral and contralateral MCA aneurysms were successfully clipped via unilateral approach. In the remaining 10 cases, bilateral approach was necessary because of some technical difficulties. Although the surgical results were almost the same, mean operation time and mean hospital stay were, respectively, 46 and 37 % shorter and mean cost per person was 23 % lower for the patients in the unilateral group. In addition, the severity of brain edema, total length of the contralateral (A1+M1) segment, and the configuration of contralateral aneurysm were found to be the determinant parameters affecting the feasibility of the unilateral approach. To our knowledge, this is the first study in the literature that compares the clinical outcomes of unilateral and bilateral approaches to bMCA aneurysms. The results of surgery for both approaches are almost the same. However, the unilateral approach has certain advantages compared to the bilateral approach. Therefore, the unilateral approach may be a good alternative in surgical management of patients with bMCA aneurysms in selected cases and the abovementioned parameters can help the neurosurgeon in patient selection.
authors.affiliation: Department of Neurosurgery, School of Medicine, University of Hacettepe, Ankara, Turkey. servet@mailcity.com
authors.forename: Servet
authors.initials: S
authors.lastname: Inci
authors.forename: Atilla
authors.initials: A
authors.lastname: Akbay
authors.forename: Tuncalp
authors.initials: T
authors.lastname: Ozgen
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery; D015901:Angiography, Digital Subtraction; D001929:Brain Edema / Q000209:etiology / Q000473:pathology; D002533:Cerebral Angiography; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology