title: Outcome for unruptured middle cerebral artery aneurysm treatment: surgical and endovascular approach in a single center.
abstract: The rupture of an intracranial aneurysm leads to subarachnoid hemorrhage (SAH). To prevent SAH, unruptured lesions can be treated by either endovascular or microsurgical approach. Due to their complex anatomy, middle cerebral artery (MCA) aneurysms represent a unique subgroup of intracranial aneurysms. Primary objective was to determine radiological and clinical outcomes in patients with middle cerebral artery aneurysms who were interdisciplinary treated by either endovascular or microsurgical approach in a single center. Secondary objective was to determine the impact of the lesions' angiographic characteristics on treatment outcome. Clinical and radiological data of 103 patients interdisciplinary treated for unruptured MCA aneurysms over a 5-year period were analyzed in endovascular (n = 16) and microsurgical (n = 87) cohorts. Overall morbidity (Glasgow Outcome Score <5) after 12-month follow-up was 9 %. There was no significant difference between the two cohorts. Complete or "near complete" aneurysm occlusion was achieved in 97 and 75 % in the microsurgical, respective endovascular cohort. A "complex" aneurysm configuration had a significant impact on complete aneurysm occlusion in both cohorts, however, not on clinical outcome. Treatment of unruptured MCA aneurysms can be performed with a low risk of repair using both approaches. However, the risk for incomplete occlusion was higher for the endovascular approach in this series.
authors.affiliation: Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany, philippdammann@gmx.net.
authors.forename: Philipp
authors.initials: P
authors.lastname: Dammann
authors.forename: Tobias
authors.initials: T
authors.lastname: Schoemberg
authors.forename: Oliver
authors.initials: O
authors.lastname: Müller
authors.forename: Neriman
authors.initials: N
authors.lastname: Özkan
authors.forename: Marc
authors.initials: M
authors.lastname: Schlamann
authors.forename: Isabel
authors.initials: I
authors.lastname: Wanke
authors.forename: I Erol
authors.initials: IE
authors.lastname: Sandalcioglu
authors.forename: Michael
authors.initials: M
authors.lastname: Forsting
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery; D002533:Cerebral Angiography; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome