Treatment of middle cerebral artery aneurysms: A comparative study and proposed treatment algorithm.

[OBJECTIVES] We aimed to compare outcomes of patients with middle cerebral artery (MCA) aneurysms treated by either microsurgical clipping or endovascular therapy and provide a treatment algorithm based on available evidence.

[MATERIALS AND METHODS] We performed a retrospective analysis of 77 patients with 95 MCA aneurysms. Demographic, clinical, and aneurysm morphological variables were collected. Patients were divided into two groups depending on the received treatment. Clinical and radiological outcomes were collected at the end of a 1-year follow-up period and compared between both treatment groups.

[RESULTS] Mean age was 51.4 years. Fifty patients (65%) underwent microsurgical clipping and 27 (35%) were treated by endovascular therapy. Fifty-four patients (70%) presented with subarachnoid hemorrhage, while 23 (30%) were treated for unruptured aneurysms. Patients with subarachnoid hemorrhage were more frequently treated by microsurgical clipping than patients with unruptured aneurysms. Clinical outcomes, including functional status, were similar between treatment groups after 1-year follow-up even when adjusting for clinical presentation. Residual aneurysms were found less frequently in the microsurgical group (OR = 0.09; p < 0.001).

[CONCLUSIONS] In patients with MCA aneurysms, clinical outcomes at 1 year are similar between microsurgical clipping and endovascular therapy. However, microsurgery is associated with a lower risk of residual aneurysms.