Microsurgical Clipping of Unruptured Middle Cerebral Artery Bifurcation Aneurysms: Incidence of and Risk Factors for Procedure-Related Complications

• Published in: World neurosurgery Vol. 83; no. 5; pp. 666 - 672
• Main Authors: Chung, Joonho, Hong, Chang-Ki, Shim, Yu Shik, Joo, Jin-Yang, Lim, Yong Cheol, Shin, Yong Sam, Kim, Yong Bae
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2015
• Subjects: Adult; Aged; Aged, 80 and over; Angiography, Digital Subtraction; Cerebral Revascularization - adverse effects; Cerebral Revascularization - methods; Complications; Female; Follow-Up Studies; Humans; Incidence; Intracranial aneurysm; Intracranial Aneurysm - surgery; Male; Microsurgical clipping; Middle Aged; Middle cerebral artery; Middle Cerebral Artery - surgery; Neurosurgery; Postoperative Complications - epidemiology; Predictors; Retrospective Studies; Risk Factors; Unruptured aneurysm; Digital subtraction angiography; EVT; Endovascular treatment; Complications; Unruptured aneurysm; CI; ICA; Middle cerebral artery; Lenticulostriate artery; MCA; Intracerebral hemorrhage; Confidence interval; ICH; Dt; CT; DSA; Computed tomography; Distance between internal carotid artery bifurcation and middle cerebral artery bifurcation; Intracranial aneurysm; Internal carotid artery; Microsurgical clipping; LSA; Predictors
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2015.01.023

Objective To report our experiences in microsurgical clipping of unruptured middle cerebral artery (MCA) bifurcation aneurysms and to evaluate the incidence of and risk factors for procedure-related complications. Methods The study comprised 416 patients treated between March 2003 and February 2014. All patients met the following criteria: 1) microsurgical clipping of an unruptured MCA bifurcation aneurysm was performed, and 2) clinical and radiographic follow-up data were available including preoperative digital subtraction angiography. The incidence of and risk factors for procedure-related complications were retrospectively evaluated. Results Procedure-related complications occurred in 15 (3.6%) patients, including asymptomatic complications in 10 (2.4%) patients and symptomatic complications in 5 (1.2%) patients. Multivariate logistic regression analysis showed that posteroinferior projection of the aneurysm (odds ratio = 2.814, 95% confidence interval = 0.995–6.471, P  = 0.042), distance between the internal carotid artery bifurcation and the MCA bifurcation (Dt) in a linear line (odds ratio = 1.813, 95% confidence interval = 0.808–6.173, P  = 0.043), and horizontal angle between the vertical line to the base of the skull and Dt (odds ratio = 2.046, 95% confidence interval = 1.048–10.822, P  = 0.048) were independent risk factors for procedure-related complications. Conclusions When performing clipping of unruptured MCA bifurcation aneurysms, the procedure-related complication rate was 3.6%. Patients with MCA bifurcation aneurysms with posteroinferior projection, shorter Dt, and larger horizontal angle may be at a higher risk of procedure-related complications when performing microsurgical clipping.