Intracranial Aneurysm
Classification and therapeutic strategy of the middle cerebral artery bifurcation aneurysms
Youda Wang, Feng Guo, Dexin Zhang, Jinxing Li, Jing Cai, Jianjun Yu, Fanguo Meng
Published 2018-05-28
Cite as Chin J Neurosurg, 2018, 34(5): 467-471. DOI: 10.3760/cma.j.issn.1001-2346.2018.05.009
Abstract
ObjectiveTo investigate the anatomic classification and therapeutic strategy of the middle cerebral artery (MCA) bifurcation aneurysms.
MethodsA retrospective analysis was conducted about the clinical data of 118 patients with MCA bifurcation aneurysms treated at Department of Neurosurgery, Linyi People's Hospital from January 2013 to July 2016. According to the way of treatment, all subjects were divided into the ligation group (66 cases) and intervention group (52 cases). Based on the imaging data, the patients were divided into classical type (46 cases), unilateral type (49 cases) and double- or multiple-trunks-involved type (23 cases). The treatment outcome was assessed using the modified Rankin scale (mRS) and compared between different groups.
ResultsAmong the 46 patients with classical type of MCA bifurcation aneurysms, 27 underwent ligation and the mRS scores were 0-2 in 20 cases and 3-5 in 7; 19 patients accepted interventional embolization and their mRS scores were 0-2 in 14 cases and 3-5 in 5. There was no statistically significant difference in clinical outcomes between the groups of surgical ligation and endovascular treatment (P >0.05). Among the 49 patients with unilateral type of MCA bifurcation aneurysms, 21 underwent surgical ligation and the mRS scores were 0-2 in 11 cases and 3-5 in 10; 28 underwent interventional embolization and their mRS scores were 0-2 in 23 cases and 3-5 in 5. The clinical outcome of interventional embolization was better than that of surgical clipping (P<0.05). Among the 23 patients with double- or multiple-trunks-involved type of aneurysms, 14 patients underwent surgical clipping and the mRS scores were 0-2 in 7 cases and points and 3-5 in 7; 9 patients underwent endovascular embolization and the mRS scores were 0-2 in 4 cases and 3-5 in 5. The clinical effect of surgical clipping was better than that of interventional embolization (P<0.05).
ConclusionsFor classical type of MCA bifurcation aneurysms, the 2 treatment methods had not significantly difference in the outcome. For unilateral type of MCA bifurcation aneurysms, the prognosis of interventional embolization seems better than that of surgical clipping. Surgical clipping might be more advantageous for double- or multiple-trunks-involved type aneurysms.
Key words:
Intracranial aneurysm; Middle cerebral artery; Embolization, therapeutic; Microsurgery; Anatomical classification
Contributor Information
Youda Wang
Department of Neurosurgery, Linyi Central Hospital, Linyi 276400, China
Feng Guo
Dexin Zhang
Jinxing Li
Jing Cai
Jianjun Yu
Fanguo Meng
