• Laligam N Sekhar, Dinko Stimac, Abdurrahman Bakir, and Ramin Rak.
• Department of Neurosurgery, North Shore University Hospital, Great Neck, New York 11021, USA. lsekhar@nshs.edu
• Neurosurgery. 2005 Jan 1; 56 (1 Suppl): 66-74; discussion 66-74.

ObjectiveTo describe techniques of reconstruction for unclippable and uncoilable middle cerebral artery aneurysms.MethodsA retrospective review was performed of seven patients who underwent eight operations during a 9-year period to treat complex middle cerebral artery bifurcation aneurysms not amenable to direct clipping or endovascular coiling. All preoperative and postoperative clinical and imaging data were reviewed. Follow-up was obtained for all patients via clinic visit and/or telephone.ResultsThe operative techniques used included saphenous vein graft bypass (n = 1), radial artery graft interposition (n = 2), radial artery patch (n = 1), superficial temporal artery interposition graft (n = 1), superior thyroid artery interposition graft (n = 1), direct reimplantation of branch (n = 1), and reconstruction of trifurcation (n = 1). There was no mortality. Six patients had excellent outcomes with Glasgow Outcome Scale scores of 5, and one patient had a good outcome with a Glasgow Outcome Scale score of 4.ConclusionTechniques for middle cerebral artery reconstruction may remain important and useful in the age of endovascular aneurysm treatment.

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