MULTIDISCIPLINARY MANAGEMENT OF MIDDLE CEREBRAL ARTERY ANEURYSMS: A RETROSPECTIVE SINGLE-CENTER CASE SERIES WITH 328 CONSECUTIVE PATIENTS

Details

Supervisors

Raftopoulos, Christian ; Finet, Patrice

Faculty

Faculté de médecine et médecine dentaire

Degree label

Master [180] en médecine

Abstract

Objective: The purpose of the study is to analyze the results of surgical and endovascular managements of middle cerebral artery aneurysms in terms of efficacy and safety. Material and methods: We conducted a single-center retrospective study of 328 consecutive patients diagnosed with 421 MCA aneurysms at our institution (academic hospital Saint-Luc) between February 1996 and November 2016. Primary treatments were assigned after interdisciplinary discussion. Three hundred and fifty-two treatments were carried out: surgical technique was performed on 279 aneurysms (201 unruptured and 78 ruptured) and 73 aneurysms underwent endovascular repair (53 unruptured and 20 ruptured). Results: Initial angiographic studies revealed complete obliteration in 97% and 45.3% of unruptured aneurysms (UIA) treated by surgery (NST) and coiling (EVT), respectively (p <0.0001). Total occlusion was achieved in 92.3% and 45% of ruptured aneurysms (RIA) that underwent, respectively, NST and EVT (p <0.0001). A higher incidence of intraoperative complications was found in EVT group compared to NST group for both UIA (21% versus 5%, p=0.0008) and RIA (25% versus 19%, p=0.55). Treatment-related permanent morbidity for UIA was 0.5% of those repaired surgically and 3.8% of those embolized (p=0.11). The mortality rate from the treatment of these aneurysms was nil. Cumulative procedure-related morbidity and mortality for RIA was 9% after NST and 5% after EVT (p=1). No statistically significant difference was found in clinical outcomes at discharge and follow-up between both groups of treatment. Early retreatment due to failure of procedure or initially incomplete occlusion was 23.3% in EVT group compared with 0.7% in NST group (p<0.0001). Recanalization was observed in 14.3% of aneurysms treated by EVT and in 6.1% of those treated by NST (p=0.0007). Late retreatment, due to aneurysmal recurrence, was 2.7% in EVT group and 1.4% for surgically treated aneurysms (p=0.61). Conclusion: Based on our experience, we can assert the superiority of neurosurgery over endovascular therapy in regard to short-term and long-term efficacy. Therefore, we can ascertain that the surgical approach still leads the way in the management of MCA aneurysms despite the major advances in endovascular techniques. However, in terms of safety, similar clinical outcomes are achieved with both treatments. Thus, the decision about the treatment strategy should be made within a multidisciplinary framework and on an individual basis to provide optimal management.