Surgical Treatment of Distal Middle Cerebral Artery Aneurysms

Sung, Soon Ki; Cho, Won Ho; Lee, Sang Weon; Choi, Chang Hwa

Abstract

OBJECT: The aneurysms located in the distal middle cerebral artery (MCA) are uncommon and have not been well investigated previously. To clarify these lesions more fully, we undertook a retrospective analysis of the clinical features and managements of the 9 consecutive patients treated at our institution.
METHODS
Nine patients with distal MCA aneurysms treated at our department between 1994 and 2003 were reviewed retrospectively. We performed analysis on the basis of clinical profiles, radiological and intraoperative findings. RESULT: In our series, the incidence of distal MCA aneurysms was 1.1% of all intracranial aneurysms and 3.7% all MCA aneurysms. There were seven ruptured and two unruptured distal MCA aneurysms. All aneurysms were presumed typical saccular aneurysms in the angiographic and intraoperative findings and there were no past medical history, evidence of previous infection, trauma and neoplastic disorders. The nine patients consisted of seven women and two men ranging in age from 42 to 61 years. Eight aneurysms were located in the left side and only one aneurysm in the right side. Five of seven ruptured patients sustained an subarachnoid hemorrhage (SAH) with intracerebral hematoma (ICH) in the initial computed tomography (CT) scans. Although three patients presented transient speech disturbance postoperatively, good clinical outcome was achived in the eight of nine patients.
CONCLUSION
Distal MCA aneurysms have tendency of female and left side predominency and easily cause ICH with SAH, but majority of them showed a favorable outcome. It was difficult to find the exact location of aneurysms during dissection. To obtain successful clippng of aneurysms and avoid the operation related complications, surgeons must dissect the sylvian fissure sufficiently and retract frontal lobe carefully.