title: Endovascular treatment of proximal superior middle cerebral artery aneurysms.
abstract: BACKGROUND
  Aneurysms superiorly located on the proximal segment of the middle cerebral artery (PMCAA) are rare and challenging to treat. No information is available regarding their management by endovascular approach. The aim of this study was to report our experience with endovascular treatment (EVT) of PMCAA.
  
  
  METHODS
  A retrospective review of our prospectively maintained database identified all PMCAA treated in our institution. The clinical charts, procedural data, and angiographic results were reviewed.
  
  
  RESULTS
  From April 2004 to December 2011, 17 patients were identified including six who presented with subarachnoid hemorrhage (SAH) and 11 with an unruptured PMCAA. All aneurysms were small (<6 mm) and had a branch arising from the neck or the sac, and 15/17 were wide-necked. All patients were successfully treated by balloon-assisted coiling (n = 10), stent-assisted coiling (n = 5), and coiling (n = 2). No technical or clinical complication occurred. Fifteen patients showed an excellent clinical outcome, and two kept a slight or a significant deficit that were both SAH-related. Immediate anatomical outcome includes nine complete occlusions and eight neck remnants. Imaging follow-up in 11 patients (mean = 21, range, 6 to 60 months) showed stable or improved results in all cases.
  
  
  CONCLUSIONS
  Our study is the first reported series of patients with PMCAA treated by selective embolization. It suggests that EVT is a safe and effective alternative to surgery for the management of PMCAA. Balloon- or stent-assisted coiling are needed in most cases because of PMCAA morphological characteristics.
authors.affiliation: Department of Neuroradiology, Erasme University Hospital, Brussels, Belgium. blubicz@ulb.ac.be
authors.forename: Boris
authors.initials: B
authors.lastname: Lubicz
authors.forename: Martina
authors.initials: M
authors.lastname: Pezzullo
authors.forename: Denis
authors.initials: D
authors.lastname: Brisbois
authors.forename: Olivier
authors.initials: O
authors.lastname: De Witte
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult