• Thomas Metayer, Arthur Leclerc, Alin Borha, Stephane Derrey, Olivier Langlois, Charlotte Barbier, Sorin Aldea, Caroline le Guerinel, Michel Piotin, Denis Vivien, Anaïs R Briant, Evelyne Emery, and Thomas Gaberel.
• Department of Neurosurgery, University Hospital of Caen, Caen, France; UNICAEN, INSERM, U1237, Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain at Caen-Normandie, Cyceron, Normandie University, Caen, France. Electronic address: thomas.metayer@neurochirurgie.fr.
• World Neurosurg. 2022 Dec 1; 168: e87e96e87-e96.

ObjectiveMiddle cerebral artery aneurysms (MCAAs) have been considered good candidates for microsurgery. Our objective was to evaluate the risk of complications and the risk factors for complications with microsurgical treatment of MCAAs to better define the indications for microsurgery.MethodsWe conducted a retrospective cohort study from 3 tertiary neurosurgical units from January 2013 to May 2020. We evaluated the frequency of complications and searched for the risk factors for complications after microsurgery. Complications were defined as a composite criterion with the presence of one of the following: procedural-related death, symptomatic cerebral ischemia, impossible exclusion, incomplete exclusion, or rebleeding of the treated aneurysm and symptomatic surgical site hematoma.ResultsA total of 292 MCAAs were treated, with 29 complications (9.9%), including symptomatic cerebral ischemia (4.8%), aneurysm rebleeding (0.3%), surgical site hematoma (1.0%), impossible exclusion (0.3%), and incomplete exclusion (4.1%). Severe complications, defined as death or a modified Rankin scale score of ≥4 at 3 months, were infrequent, occurring in 7 of the 292 patients (2.4%). On multivariate analysis, the risk factors were a ruptured aneurysm, a larger maximum aneurysm size, a larger neck size, and arterial branches passing <1 mm from the aneurysm neck or dome.ConclusionsMicrosurgical management of MCAAs can be performed with very low morbidity rates. In some cases, at least for factors that do not result in significant difficulty for endovascular therapy, such as the presence of an en passage artery or ruptured aneurysm, endovascular therapy can be considered to be as safe and effective as clipping.Copyright © 2022 Elsevier Inc. All rights reserved.

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