Microsurgical Clipping of Unruptured Middle Cerebral Artery Bifurcation Aneurysms: A Single-Center Experience
Background/Objectives: Microsurgical clipping has traditionally been considered a standard treatment for middle cerebral artery (MCA) aneurysms. Recently, a caseload reduction related to improved endovascular treatment options has occurred in cerebrovascular neurosurgery. Therefore, studies that rep...
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2024-10-01
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| author | Nico Stroh-Holly Philip Rauch Harald Stefanits Philipp Hermann Helga Wagner Michael Sonnberger Maria Gollwitzer Stefan Aspalter Andreas Gruber Matthias Gmeiner |
| author_facet | Nico Stroh-Holly Philip Rauch Harald Stefanits Philipp Hermann Helga Wagner Michael Sonnberger Maria Gollwitzer Stefan Aspalter Andreas Gruber Matthias Gmeiner |
| author_sort | Nico Stroh-Holly |
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| description | Background/Objectives: Microsurgical clipping has traditionally been considered a standard treatment for middle cerebral artery (MCA) aneurysms. Recently, a caseload reduction related to improved endovascular treatment options has occurred in cerebrovascular neurosurgery. Therefore, studies that report the clinical and radiological outcomes after clipping are highly warranted. Methods: Patients with an unruptured MCA bifurcation aneurysm, who were surgically treated at the Department of Neurosurgery in Linz between 2002 and 2019, were included in this study. Clinical and radiological outcome parameters were evaluated for each patient. Results: Overall, 272 patients were eligible for inclusion. Complete aneurysm occlusion was demonstrated in 266 (99.3%) of the 268 (98.5%) patients who underwent postoperative digital subtraction angiography. In six (2.2%) patients, a permanent new neurological deficit (pNND) persisted after treatment. Intraoperative aneurysm rupture was a significant factor (<i>p</i> = 0.0049) in the logistic regression. At the last follow-up, only two patients (0.7%) had an unfavorable outcome (mRS > 2). More recent surgeries were associated with fewer cases of pNND (<i>p</i> = 0.009). A transient new neurological deficit occurred in 13 patients (4.8%), with aneurysm size being a significant risk factor (<i>p</i> = 0.009). Surgical site infections were reported in four patients (1.5%), with patient age (<i>p</i> = 0.039) and time (<i>p</i> = 0.001) being significant factors. Two patients died (0.7%) perioperatively and two patients (0.7%) needed a retreatment in the long-term follow-up. Conclusions: The findings indicate that microsurgical clipping is a safe procedure with minimal need for retreatment. It achieves a high occlusion rate while maintaining a very low rate of adverse outcomes. Continuous intraoperative enhancements over time have contributed to a progressive improvement in clinical outcomes in recent years. This trend is exemplified by the absence of detectable pNND in the era of ICG angiography. Consequently, these data support the conclusion that microsurgical clipping should still be considered an appropriate treatment option for unruptured MCA bifurcation aneurysms. |
| format | Article |
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| publishDate | 2024-10-01 |
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| spelling | doaj-art-afcc957cc2eb4f66bc1394b7634ed7ad2025-08-20T02:28:07ZengMDPI AGBrain Sciences2076-34252024-10-011411106810.3390/brainsci14111068Microsurgical Clipping of Unruptured Middle Cerebral Artery Bifurcation Aneurysms: A Single-Center ExperienceNico Stroh-Holly0Philip Rauch1Harald Stefanits2Philipp Hermann3Helga Wagner4Michael Sonnberger5Maria Gollwitzer6Stefan Aspalter7Andreas Gruber8Matthias Gmeiner9Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University Linz, Wagner-Jauregg-Weg 15, A-4020 Linz, AustriaDepartment of Neurosurgery, Kepler University Hospital, Johannes Kepler University Linz, Wagner-Jauregg-Weg 15, A-4020 Linz, AustriaDepartment of Neurosurgery, Kepler University Hospital, Johannes Kepler University Linz, Wagner-Jauregg-Weg 15, A-4020 Linz, AustriaCenter for Clinical Studies (CCS Linz), Johannes Kepler University Linz, A-4040 Linz, AustriaCenter for Clinical Studies (CCS Linz), Johannes Kepler University Linz, A-4040 Linz, AustriaInstitute of Neuroradiology, Kepler University Hospital, Johannes Kepler University Linz, A-4040 Linz, AustriaDepartment of Neurosurgery, Kepler University Hospital, Johannes Kepler University Linz, Wagner-Jauregg-Weg 15, A-4020 Linz, AustriaDepartment of Neurosurgery, Kepler University Hospital, Johannes Kepler University Linz, Wagner-Jauregg-Weg 15, A-4020 Linz, AustriaDepartment of Neurosurgery, Kepler University Hospital, Johannes Kepler University Linz, Wagner-Jauregg-Weg 15, A-4020 Linz, AustriaDepartment of Neurosurgery, Kepler University Hospital, Johannes Kepler University Linz, Wagner-Jauregg-Weg 15, A-4020 Linz, AustriaBackground/Objectives: Microsurgical clipping has traditionally been considered a standard treatment for middle cerebral artery (MCA) aneurysms. Recently, a caseload reduction related to improved endovascular treatment options has occurred in cerebrovascular neurosurgery. Therefore, studies that report the clinical and radiological outcomes after clipping are highly warranted. Methods: Patients with an unruptured MCA bifurcation aneurysm, who were surgically treated at the Department of Neurosurgery in Linz between 2002 and 2019, were included in this study. Clinical and radiological outcome parameters were evaluated for each patient. Results: Overall, 272 patients were eligible for inclusion. Complete aneurysm occlusion was demonstrated in 266 (99.3%) of the 268 (98.5%) patients who underwent postoperative digital subtraction angiography. In six (2.2%) patients, a permanent new neurological deficit (pNND) persisted after treatment. Intraoperative aneurysm rupture was a significant factor (<i>p</i> = 0.0049) in the logistic regression. At the last follow-up, only two patients (0.7%) had an unfavorable outcome (mRS > 2). More recent surgeries were associated with fewer cases of pNND (<i>p</i> = 0.009). A transient new neurological deficit occurred in 13 patients (4.8%), with aneurysm size being a significant risk factor (<i>p</i> = 0.009). Surgical site infections were reported in four patients (1.5%), with patient age (<i>p</i> = 0.039) and time (<i>p</i> = 0.001) being significant factors. Two patients died (0.7%) perioperatively and two patients (0.7%) needed a retreatment in the long-term follow-up. Conclusions: The findings indicate that microsurgical clipping is a safe procedure with minimal need for retreatment. It achieves a high occlusion rate while maintaining a very low rate of adverse outcomes. Continuous intraoperative enhancements over time have contributed to a progressive improvement in clinical outcomes in recent years. This trend is exemplified by the absence of detectable pNND in the era of ICG angiography. Consequently, these data support the conclusion that microsurgical clipping should still be considered an appropriate treatment option for unruptured MCA bifurcation aneurysms.https://www.mdpi.com/2076-3425/14/11/1068intracranial aneurysmunruptured intracranial aneurysmmiddle cerebral artery aneurysmclippingmicrosurgical treatmentoutcome |
| spellingShingle | Nico Stroh-Holly Philip Rauch Harald Stefanits Philipp Hermann Helga Wagner Michael Sonnberger Maria Gollwitzer Stefan Aspalter Andreas Gruber Matthias Gmeiner Microsurgical Clipping of Unruptured Middle Cerebral Artery Bifurcation Aneurysms: A Single-Center Experience Brain Sciences intracranial aneurysm unruptured intracranial aneurysm middle cerebral artery aneurysm clipping microsurgical treatment outcome |
| title | Microsurgical Clipping of Unruptured Middle Cerebral Artery Bifurcation Aneurysms: A Single-Center Experience |
| title_full | Microsurgical Clipping of Unruptured Middle Cerebral Artery Bifurcation Aneurysms: A Single-Center Experience |
| title_fullStr | Microsurgical Clipping of Unruptured Middle Cerebral Artery Bifurcation Aneurysms: A Single-Center Experience |
| title_full_unstemmed | Microsurgical Clipping of Unruptured Middle Cerebral Artery Bifurcation Aneurysms: A Single-Center Experience |
| title_short | Microsurgical Clipping of Unruptured Middle Cerebral Artery Bifurcation Aneurysms: A Single-Center Experience |
| title_sort | microsurgical clipping of unruptured middle cerebral artery bifurcation aneurysms a single center experience |
| topic | intracranial aneurysm unruptured intracranial aneurysm middle cerebral artery aneurysm clipping microsurgical treatment outcome |
| url | https://www.mdpi.com/2076-3425/14/11/1068 |
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