title: Surgical Treatment of Middle Cerebral Artery Aneurysms Without Using Indocyanine Green Videoangiography Assistance: Retrospective Monocentric Study of 263 Clipped Aneurysms.
abstract: BACKGROUND
  Middle cerebral artery (MCA) aneurysms represent 20% of intracranial aneurysms. Most (80%) of them are located on the sylvian bifurcation, the seat of hemodynamic turbulence flow. Morbidity and mortality related to surgery of MCA aneurysms are not negligible. MCA vascularization areas are important eloquence functional territorial of Brain tissue. Indocyanine green videoangiography assistance (ICG-VA) is an emergent tool for intraoperative assessment of aneurysmal occlusion and for checking a possible stenosant clip in vascular area. The purposes of this study were to evaluate the safety of clipping procedure in terms of morbidity, mortality, and efficiency of aneurysm occlusion without using ICG-VA, recurrence and bleeding/rebleeding at short and long terms, and angiographic and clinical follow-ups.
  
  
  METHODS
  This study is a monocentric retrospective study performed at Pitié-Salpêtrière-Charles Foix Hospital Center, reporting clinical and angiographic follow-up of consecutive patients treated for MCA aneurysms (ruptured and unruptured) by clipping procedures. From 2002-2012, 251 consecutive patients were admitted at the author's institution for treatment of 263 MCA aneurysms (163 ruptured and 100 unruptured). Procedure-related death and complications were systematically assessed without video-angiography availability. The degree of aneurysms exclusion was evaluated according to the Raymond-Roy scale after the procedure and at long-term angiographic follow-up (mean delay = 36 months).
  
  
  RESULTS
  The death rate related to aneurysmal exclusion procedure was 1.2%. The major complication rate related to surgery was 5.3%. Postprocedure, an aneurysm occlusion rate Raymond-Roy grade A or B was 95.6%. Neither recanalization controlled clipped aneurysms nor re-aneurysmal rupture was observed in the long-term clinical follow-up (mean time = 83.5 months). The institution's series of surgical outcomes reported 95.6% of complete exclusion and 4.5% incomplete procedures without ICG-VA. A clip of repositioning rate was estimated at 15% when ICG-VA was used.
  
  
  CONCLUSIONS
  Surgical management is relatively safe for patients, with an acceptable complication rate in the era when ICG-VA was not yet available. Indeed, the main source of procedural ischemia microsurgery is stenosant clip. To limit the occurrence of malposition, the author's center began using ICG-VA a few months ago and expects to reduce its rate of incomplete occlusion.
authors.affiliation: Pitié-Salpêtrière-Charles Foix Hospital Center, Paris, France. Electronic address: sabrina.hallout@neurochirurgie.fr.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Hallout
mesh_terms: D017542:Aneurysm, Ruptured / Q000601:surgery; D016063:Blood Loss, Surgical; D002533:Cerebral Angiography / Q000379:methods*; D004396:Coloring Agents; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D002532:Intracranial Aneurysm / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Clip; Intracranial aneurysm; Middle cerebral artery; Stroke; Subarachnoid hemorrhage; Videoangiography