Microsurgical Treatment of Middle Cerebral Artery Aneurysms

Chung, Bong Sub; Lee, Kyu Chang

Abstract

The authors analyzed 50 microsurgically treated middle cerebral artery(MCA) aneurysms among 266 intracranial aneurysms in the Department of Neurosurgery, Yonsei University Hospital from September 1975 through September 1982, in order to study the differences from those of other intracranial aneurysms, and analyze the surgical outcome versus preoperative clinical status of the patients, surgical timing, and the microsurgical techniques. The results of the analysis were summarized as follows ; 1) The middle cerebral artery aneurysms occupied 19.5% of the microsurgically treated intracranial aneurysms. 2) The brain CT scan showed subarachnoid hemorrhage in 77.5%, hemorrhage in the unilateral Sylvian cistern in 39.7%, and intracranial hematoma in 48.4%. 3) The most common location of middle cerebral artery aneurysms was the M1 M2 junction in 84%, and MCA bifurcation aneurysms occupied 44%, and trifurcation ones 40%. 4) Clipping with reinforcement of the aneurysms were performed in 74% of total cases due to difficult complete clipping of the aneurysmal neck. And the rest were wrapped. 5) The surgical timing was around the 3rd week after the last bleeding in most cases. 6) Patients in Botterell's grade I to III showed no motality and good surgical outcome. Only one case of grade V expired postoperatively, and morbidity was 10%.