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Open Access 01-11-2011 | Clinical Article

Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

Authors: J. Marc C. van Dijk, Rob J. M. Groen, Mark Ter Laan, Johanna Rinck Jeltema, Jan Jacob A. Mooij, Jan D.M. Metzemaekers

Published in: Acta Neurochirurgica | Issue 11/2011

Abstract

Objective

In recent years the endovascular treatment of intracranial aneurysms (coiling) has progressively gained recognition, particularly after the publication of the International Subarachnoid Aneurysm Trial (ISAT) in 2002. Despite the fact that in ISAT middle cerebral artery (MCA) aneurysms were clearly underrepresented, the study is often used as an argument to favor coiling above surgery in MCA aneurysms. Taken into account that MCA aneurysms are very well accessible for surgery, a contemporary assessment of the benefits of a preferred surgical strategy for MCA aneurysms was performed in a tertiary neurovascular referral center.

Methods

A prospectively kept single-center database of 151 consecutive patients with an MCA aneurysm was reviewed over a 6-year period (2001–2006). Long-term follow-up after surgical treatment of a ruptured MCA aneurysm was obtained in 74 out of 77 (96%) patients. The outcome was compared with relevant series in the literature.

Results

After a mean follow-up of 4.7 years, 59 out of 74 surgically treated patients (80%) with a ruptured MCA aneurysm had a good outcome (mRankin 0–2). All patients with an unruptured MCA aneurysm also had a good outcome after clipping. This is well-matched with the findings of the literature search, and competitive with the endovascular results.

Conclusion

Surgical clipping is recommended as the principal treatment strategy for MCA aneurysms. This is not only ethically defendable in view of the surgical results but also in line with a strategy to maintain surgical experience within centralized neurovascular centers.

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Title: Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery
Authors: J. Marc C. van Dijk
Rob J. M. Groen
Mark Ter Laan
Johanna Rinck Jeltema
Jan Jacob A. Mooij
Jan D.M. Metzemaekers
Publication date: 01-11-2011
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 11/2011
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-011-1139-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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