• World Neurosurg · Nov 2021

    Giant middle cerebral artery aneurysms: A 55-patient series.

    • Yuri Pilipenko, Shalva Eliava, Arevik Abramyan, Fedor Grebenev, Tatiana Birg, Ali Kheireddin, Oleg Shekhtman, and Sergey Arustamyan.
    • Federal State Autonomous Institution N. N. Burdenko, National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation (N.N. Burdenko NMRCN), Moscow, Russia. Electronic address: 3664656@mail.ru.
    • World Neurosurg. 2021 Nov 1; 155: e727-e737.

    BackgroundThe treatment of middle cerebral artery (MCA) giant aneurysms (GAs) represents a challenging task.MethodsThe data for 55 patients treated for MCA GA (≥25 mm) at the N.N. Burdenko NMRCN between 2010 and 2019 were analyZed.ResultsThe GAs were located in the M1 segment in 11 (20%) patients, MCA bifurcation in 33 (60%), M2 in 7 (12.7%), and M3 in 4 (7.3%). There were 32 (58.2%) saccular and 23 (41.8%) fusiform GAs. MCA GAs were treated with neck clipping (50.9%), clipping with the artery lumen formation (3.6%), bypass surgeries (34.5%), wrapping (3.6%), and endovascular surgery (7.3%). A worsening of the neurologic state in the perioperative period was observed in 50.9% of patients. The complete closure of GA was achieved in 78.2%. Surgery-related mortality was 1.8%. The long-term outcome was favorable in 76.9% of patients. Surgery-related and disease-related plus treatment failures-related mortality was 9.6%.ConclusionsMicrosurgical clipping and bypass surgery are the main operative interventions for MCA GA treatment. These operations are technically complex and are followed by a relatively high percentage of complications. The main tasks that require further investigations are the introduction of new precise diagnostic methods for the collateral circulation assessment in the cortical MCA branches, the perfection of the algorithm for the bypass selection, and investigation of the long-term results of the endovascular and combined treatments. It is of major importance to thoroughly observe the patients long-term after the surgery and ensure the possibility for further angiographic studies.Copyright © 2021 Elsevier Inc. All rights reserved.

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