Surgical Treatment Of Middle Cerebral Artery Aneurysms And Microanatomy Of Middle Cerebral Artery

Objective In order to improve the diagnostic and therapeutic level of the middle cerebral artery aneurysms , the clinical data of consecutive 155 patients with middle cerebral artery aneurysms were summarized and the microanatomy of middle cerebral artery was studied in the adult cadaver brains. We evaluate the current management strategies of patients with middle cerebral artery aneurysms and explore the prognostic factors witch have a significant association with the outcome in the paper.Methods A retrospective analysis of 155 patients with middle cerebral artery aneurysms, treated from Jan 1996 to Dec 2005 in Tianjin Huanhu Hospital, was performed. The clinical features, imaging findings, treatments and complications were summarized and the prognostic factors which have a significant association with the outcome of the surgery of the single middle cerebral artery aneurysms were explored. In order to improve the understanding of the microanatomy of middle cerebral artery, the microanatomy of middle cerebral artery (MCA) was studied in 10 adult cadaver brains under operative microscope. Results For 133 patients with single middle cerebral artery aneurysms, 87 patients were treated by microsurgical operation and 46 patients were treated by endovascular coiling. 54 patients had a good outcome after microsurgical operation and 33 patients had a poor outcome. 39 patients had a good outcome after endovascular coiling and 7 patients had a good outcome. In univariate the following factors was analysedsignificant influence on outcome after microsurgical operation for single middle cerebral artery aneurysms: the pre-operational Hunt-Hess grading, age, the aneurysm rupture times , the time of surgery and with intracerebral haematomas. On multivariate analysis only the pre-operational Hunt-Hess grading and age retained significance. For 22 patients with multiple intracranial aneurysms who had at least one middle cerebral artery aneurysm, 15 patients were treated by microsurgical operation and 7 patients were treated by endovascular coiling. 11 patients had a good outcome after microsurgical operation and 4 patients had a poor outcome. 6 patients had a good outcome after endovascular coiling and 1 patients had a poor outcome. In the anatomy study, the outer diameter of the MCA at its origin is 3.13±0.12 mm(2. 56~4. 22mm). The main trunk of the Ml segment ended in a bifurcation in 85% hemispheres and a trifurcation in 10%, a single trunk in the remaining 5%. The length of the main trunk from the artery's origin to is main bifurcation was 14.38+1.32 mm mm (10. 28~33. 58mm) .In the 20 hemispheres, a total of 151 lenticulostriate arterys , an mean of 7.55±2. 16 lenticulostriate arterys was founded. The largest cortical artery is the temporo-occipital artery.Conclusion Middle cerebral artery aneurysms cause one-fifth of all aneurysmal subarachnoid hemorrhages. Although it is common, the treatment outcome of this lesion is not always satisfied. Microsurgical operation is the first choice for treating Middle cerebral artery aneurysms. For some selective patients, endovascularcoiling also could cause good outcome and endovascular coiling is minimal invasive, safe and effective. For the treatment of patients with multiple intracranial aneurysms who had at least one middle cerebral artery aneurysm, all aneurysms should be treated in one stage if possible. The ruptured aneurysm should be first treated when treated by either microsurgical operation or endovascular coiling. Middle cerebral artery supply the importment functional regions. It is essential for avoiding damage to its branches and perforating artery during operation to gain a good outcome.