Efficacy and safety of surgical treatment for middle cerebral artery aneurysms: A retrospective case series

Objective: The purpose of this study was to evaluate the efficacy and safety of surgical treatment for aneurysms of the middle cerebral artery at a Brazilian Vascular Neurosurgical Center. Methods: A retrospective review was conducted of the medical records of 194 patients (213 aneurysms) operated on by the primary author at the Santa Casa Neurosurgery service in Belo Horizonte, Minas Gerais, Brazil. This study evaluated clinical outcome, treatment efficacy and mortality. Results: Overall analysis showed that 146 patients (75.2%) demonstrated ago od outcome. Evaluation of patient evolution showed that 78 patients (69.0%) with a ruptured aneurysm had a good outcome, and among patients with unrupture aneurysms, 68 (88.3%) had a good outcome at discharge (p = 0.005). Among patients with unruptured aneurysms, noneof the factors analyzed had statistically significant differences in terms of outcome. Among patients with ruptured aneurysms, the HH on admission, Fisher grade and presence of hematoma were significantly associated with clinical outcome. Multivariate analysis showed that only HH on admission was associated with prognosis. Postoperative arteriography demonstrated complete occlusion in 177 cases (83.1%). Conclusion: This study demonstrated that surgical treatment for middle cerebral artery aneurysms is safe and effective. In the overall analysis, ruptured aneurysms predicted poor outcome. None of the variables studied predicted poor outcome among patients with unruptured aneurysms. In univariate analysis, patients with ruptured aneurysms, HH on admission, Fisher grade and presence of hematoma were associated with outcome; in multivariate analysis, only HH on admission was associated with prognosis.