Microsurgical management of complex middle cerebral artery aneurysms

Introduction Management of complex aneurysms of the middle cerebral artery (MCA) is very challenging and require individualized treatment strategies. The aim of our review was to analyze experience with the treatment of complex MCA aneurysms using revascularization and artery sacrifice techniques. Methods We have reviewed 9 original articles on patients' treatment with complex MCA aneurysms. Depending on localization of complex aneurysm of MCA various methods of parent artery sacrifice, revascularization strategies, surgical results, outcomes and complications were reviewed. Results We have analyzed treatment of 244 patients with 246 complex MCA aneurysms in 9 different groups. From 67 to 100% of cases the aneurysms were occluded successfully. Bypass patency being a result of the performed revascularization methods was from 83.3 to 100%. The main complications included ischemic disorders related to occlusion of the bypass graft or perforators injury. Morbidity in some reviews varied from 2.4 to 6.9%. The majority of patients in late follow-up showed good outcomes 0-2 on modified Rankin scale and 4-5 on Glasgow Outcome Scale. Illustrative clinical cases of the patients with complex MCA aneurysms treated at the Federal Neurosurgical Center were presented. Conclusion Complex aneurysms of the MCA are very challenging lesions. The surgical strategy for treating complex MCA aneurysm should take into account vascular anatomy, complex aneurysm morphology, its localization and rupture status of each case