Microsurgical Vascular Bypass and Reconstruction in the Management of Complex Middle Cerebral Artery Aneurysms

Objectives: We conducted this study to describe and evaluate surgical strategies for the management of complex middle cerebral artery (MCA) aneurysms.

Design: This is a single-institution, nonrandomized descriptive cohort study of 33 consecutive patients treated between 1994 and 2012, mean age 46 years (range 11 to 67); There were 19 males and 14 females in this study group.

Methods: This purposes of this study are: analysis of vascular database and retrospective review of case records to include aneurysm site, size, and morphology; clinical features; surgical strategy; adjunctive endovascular treatment; complications; and outcomes (vascular and clinical).

Results: There were 17 fusiform, 14 saccular, 1 serpentine, and 1 dissecting aneurysms, involving the internal carotid artery/M1 (3/33), the M1 (9/33), MCA bifurcation (13/33), and M2 (8/33).

The surgical strategies were: EC-M2 bypass (14/33); single or multiple STA-M2 bypasses (13/33); microvascular reconstruction (7). The long-term vascular patency rate was 99%.

Outcomes:

1 death/elective (3%), 2 deaths in total, 1Ramkin III (delayed bleeding), 12 patients improved presenting outcome, 18 patients stable.

Conclusions: Good clinical outcomes may be achieved with microsurgical vascular bypasses and reconstruction for patients with complex MCA aneurysms that are otherwise untreatable and have a poor natural history.