The Discussion Of Treatment Strategies For Middle Cerebral Aneurysms

Background Middle cerebral artery aneurysm(MCAA)is a common type of intracranial aneurysm,accounting for about 18.2% to 20.8% of cases,and the incidence of intracranial hematoma after rupture is 30% to 50%,posing a serious threat to patients’ lives.The goal of definitive treatment of MCAA(whether ruptured or unruptured)is to occlude the lumen without disturbing normal circulation,thereby reducing or even eliminating the risk of further rupture.To achieve this,the standard of care is craniotomy and interventional embolization.To date,many studies have compared the effects of both on patient outcomes in an attempt to demonstrate the superiority of one treatment modality over the other,but none has been definitive.Objective To investigate the treatment strategies for middle cerebral artery aneurysms by studying and analyzing the individualized selection and complementarity of open clamping and interventional embolization procedures for middle cerebral artery aneurysms,as well as the clinical outcomes of the two treatment methods.Methods Patients with middle cerebral artery aneurysms admitted to the Department of Neurosurgery at the First Affiliated Hospital of Dalian Medical University from October 2019 to October 2022 were retrospectively collected.A total of 116 patients with middle cerebral artery aneurysms were collected for preoperative conditions,intraoperative aneurysm-related indicators,postoperative complications and recurrence rates,recovery at discharge,and follow-up outcomes.The remaining 102 patients were divided into two groups,including 63 patients treated with craniotomy and 39 patients treated with interventional embolization,and the differences between the two groups were compared and followed up.Results The results of the study between the two groups were that there were no significant differences in the preoperative data of the two groups,no statistically significant differences in the study indexes related to the classification of the patients’ disease and clinical status and imaging data,and no statistically significant differences in the study indexes related to the morphological characteristics of the aneurysm.Poor prognosis and MRS score ≥3 were observed in 11(10.8%)of the patients enrolled in the study,including 6(9.5%)in the open clamping group and 5(12.8%)in the interventional embolization treatment group.By comparing the prognosis between the two groups,the results showed no significant differences.Postoperative review of the rate of complete occlusion of the aneurysm showed that the rate of complete occlusion was higher in the clamping group(93.7%)than in the interventional group(84.6%),and the rate of patients with aneurysmal neck visualization in the interventional embolization group was high in the postoperative follow-up.Of all 29 postoperative complication events,20(34.9%)were in the craniotomy group and 9(25.6%)in the embolization group,and the t-test was used to compare the differences between the two groups for each complication,which showed a p-value(0.326)greater than 0.05,with no statistically significant difference.Conclusion Individualized selection of craniotomy versus interventional embolization to treat MCAA is both safe and effective and improves patient prognosis.When making decisions for the treatment of MCAA,we should not simply consider only craniotomy or interventional embolization.In practice,physicians should have a high level of competence and knowledge of both procedures in terms of indications and treatment modalities,or establish a comprehensive cerebrovascular disease treatment center for better multidisciplinary interaction,comprehensive patient assessment,and more objective selection of treatment options for patients to avoid bias in the selection of surgical modalities to achieve the best treatment outcome.This requires clinicians to consider the specific treatment plan for MCAA patients in a comprehensive manner,and to develop the safest and most effective treatment plan based on the patient’s cranial CTA or DSA examination results,preoperative risk assessment and systemic condition;at the same time,they should also take into account the patient’s wishes and financial ability,and finally choose the optimal personalized treatment plan to maximize the survival rate and ensure the patient’s quality of life.