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Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery.

van Dijk JM, Groen RJ, Ter Laan M, Jeltema JR, Mooij JJ, Metzemaekers JD - Acta Neurochir (Wien) (2011)

Bottom Line: The outcome was compared with relevant series in the literature.This is well-matched with the findings of the literature search, and competitive with the endovascular results.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University Medical Center Groningen, University of Groningen, The Netherlands. jmcvandijk@gmail.com

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.

Conclusion: 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.

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Outcome of the surgically treated MCA aneurysms after 2 months and after 4.7 years’ follow-up. Good = mRankin 0–2, fair = mRankin 3–4, poor = mRankin 5–6
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Fig2: Outcome of the surgically treated MCA aneurysms after 2 months and after 4.7 years’ follow-up. Good = mRankin 0–2, fair = mRankin 3–4, poor = mRankin 5–6

Mentions: Follow-up of the surgically treated symptomatic patients at 2 months was complete for all but one patient (99%). The mean follow-up was 4.7 years, obtained in 96% of the patients. The outcome was graded mRankin 0–2 in 80% of the cases (Fig. 2). During follow-up, four patients died from an unrelated cause, all more than 1 year after the aSAH and treatment.Fig. 2


Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery.

van Dijk JM, Groen RJ, Ter Laan M, Jeltema JR, Mooij JJ, Metzemaekers JD - Acta Neurochir (Wien) (2011)

Outcome of the surgically treated MCA aneurysms after 2 months and after 4.7 years’ follow-up. Good = mRankin 0–2, fair = mRankin 3–4, poor = mRankin 5–6
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3197920&req=5

Fig2: Outcome of the surgically treated MCA aneurysms after 2 months and after 4.7 years’ follow-up. Good = mRankin 0–2, fair = mRankin 3–4, poor = mRankin 5–6
Mentions: Follow-up of the surgically treated symptomatic patients at 2 months was complete for all but one patient (99%). The mean follow-up was 4.7 years, obtained in 96% of the patients. The outcome was graded mRankin 0–2 in 80% of the cases (Fig. 2). During follow-up, four patients died from an unrelated cause, all more than 1 year after the aSAH and treatment.Fig. 2

Bottom Line: The outcome was compared with relevant series in the literature.This is well-matched with the findings of the literature search, and competitive with the endovascular results.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University Medical Center Groningen, University of Groningen, The Netherlands. jmcvandijk@gmail.com

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.

Conclusion: 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.

Show MeSH
Related in: MedlinePlus