Ruptured Middle Cerebral Artery Aneurysms: A Single-Center Series Evaluating Microsurgical and Endovascular Treatment

Abstract
Background: Middle cerebral artery (MCA) represents 20% and is the 3rd most common location of intracranial aneurysms (IAs). MCA aneurysms are close to brain surface; this made surgical clipping the standard treatment for them. New advances in endovascular techniques and devices in-creased feasibility and safety of coiling of MCA aneurysms.
Aim of the Study: The aim of this study is to evaluate and compare feasibility, safety and outcome of surgical versus endovascular treatment of ruptured MCA aneurysms.
Patients and Methods: A retrospective study was done on 38 patients with ruptured MCA aneurysms who were treated between October 2013 and May 2017 at the Neurosurgery Department of Tanta University hospitals. They were divided into 2 groups: Surgical clipping (20 patients) and endovascular coiling (18 patients). Feasibility, complications and outcome were recorded and analyzed.
Results: The study included 38 patients with MCA aneu-rysms, 23 females and 15 males. The mean age was 53.5 years (20-67 years). Our microsurgical cases included 20 patients presenting with SAH and good clinical condition, Hunt & Hess score 1 and 2 in 60%. At discharge, 16 (80%) had good GOS and 4 (20%) patients had poor GOS. After endovascular management of MCA aneurysms, all the 18 cases had favorable outcome (GOS grade 5&4) which remained the same at the last follow-up. The rate of total MCA aneurysm occlusion in control angiogram performed after microvascular management was 100 % and at the last follow-up was the same. The rate of total MCA aneurysm occlusion in control angiogram at the end of the endovascular procedure was 72%, subtotal occlusion was achieved in 3 patients (17%) and incomplete occlusion in another 2 patients (11%).
Conclusion: Clipping and coiling for ruptured MCA aneurysms have comparable outcome. Microsurgery has less cost, good feasibility and more stability. Coiling has higher cost, better feasibility and less stability. However, patient selection is extremely important to optimize the outcomes.