Article
Safety and efficacy of surgical clipping and endovascular coiling in unruptured middle cerebral artery-aneurysms in a hybrid Center
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Authors
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Rahman A. Al-Schameri
- Universitätsklinik für Neurochirurgie, Christian Doppler Klinik, Paracelsus- Medizinische Privatuniversität Salzburg, Austria
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Michael Kral
- Universitätsklinik für Neurochirurgie, Christian Doppler Klinik, Paracelsus- Medizinische Privatuniversität Salzburg, Austria
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Manuel Lunzer
- Universitätsklinik für Neurochirurgie, Christian Doppler Klinik, Paracelsus- Medizinische Privatuniversität Salzburg, Austria
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Cornelia Daller
- Universitätsklinik für Neurochirurgie, Christian Doppler Klinik, Paracelsus- Medizinische Privatuniversität Salzburg, Austria
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Peter A. Winkler
- Universitätsklinik für Neurochirurgie, Christian Doppler Klinik, Paracelsus- Medizinische Privatuniversität Salzburg, Austria
| Published: | June 8, 2016 |
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Outline
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Objective: Aneurysms of the middle cerebral artery are primarily considered to be treated by surgical clipping due to easy surgical exposure. The main advantage of aneurysm clipping is its potential ability to occlude aneurysms totally and permanently. However the indication to clipping or coiling still debated. A retrospective analysis of 140 patients with unruptured MCA aneurysm who underwent surgical or endovascular treatment in our center.
Method: A series of 140 patients treated for unruptured middle cerebral artery aneurysms who underwent surgical or endovascular treatment. All patients were operated on by using standard microsurgical techniques. All fusiform and gaint aneurysms were excluded. Patient data were retrospectively entered into a computerized data base. From this data base, we extracted demographic data (name, age, sex), aneurysm location, operation date, special circumstances of surgical or endovascular therapy, complications and follow-up data (1 year out-come, mRS and GOS scores, angiographic results, and retreatment-frequency).
Results: From 140 patients 116 (82,9%) were treated microsurgically using intraoperative indocianine-angiography, micro-doppler sonography using 16 MHz ultrasound-device, and optionally intraoperative conventional angiography. Complete occlusion of the aneurysms was documented in all microsurgically treated patients. 14 (10%) patients were treated by endovascular procedure. In this group the occlusion rate was lower. 10 (7.1%) patients were treated conservatively and observed.
Conclusions: A differentiated endovascular and microsurgical approach in a hybrid-center and the exclusion of a treatment-bias concerning the choice of intervention leads to excellent results. Nervertheless the neck morphology and the incorporation of one or more M2 branches may make the endovascular access unfavorable in many cases. The advantages and drawbacks in both methods are quite different. Specifically the risk of stroke, intraprocedural rupture and specially the long term durability. Perioperative risk assessment is crucial in order to choose the less risky treatment options.
