TY - JOUR
T1 - Navigating Complexity: A Comprehensive Approach to Middle Cerebral Artery Aneurysms
AU - Auricchio, Anna Maria
AU - Di Bonaventura, Rina
AU - Marchese, Enrico
AU - Della Pepa, Giuseppe Maria
AU - Sturiale, Carmelo Lucio
AU - Menna, Grazia
AU - Skrap, Benjamin
AU - Olivi, Alessandro
AU - Albanese, Alessio
PY - 2024
Y1 - 2024
N2 - : Background: The concept of aneurysm "complexity" has undergone significant changes in recent years, with advancements in endovascular treatments. However, surgical clipping remains a relevant option for middle cerebral artery (MCA) aneurysms. Hence, the classical criteria used to define surgically complex MCA aneurysms require updating. Our objective is to review our institutional series, considering the impacts of various complexity features, and provide a treatment strategy algorithm. Methods: We conducted a retrospective review of our institutional experience with "complex MCA" aneurysms and analyzed single aneurysmal-related factors influencing treatment decisions. Results: We identified 14 complex cases, each exhibiting at least two complexity criteria, including fusiform shape (57%), large size (35%), giant size (21%), vessel branching from the sac (50%), intrasaccular thrombi (35%), and previous clipping/coiling (14%). In 92% of cases, the aneurysm had a wide neck, and 28% exhibited tortuosity or stenosis of proximal vessels. Conclusions: The optimal management of complex MCA aneurysms depends on a decision-making algorithm that considers various complexity criteria. In a modern medical setting, this process helps clarify the choice of treatment strategy, which should be tailored to factors such as aneurysm morphology and patient characteristics, including a combination of endovascular and surgical techniques.
AB - : Background: The concept of aneurysm "complexity" has undergone significant changes in recent years, with advancements in endovascular treatments. However, surgical clipping remains a relevant option for middle cerebral artery (MCA) aneurysms. Hence, the classical criteria used to define surgically complex MCA aneurysms require updating. Our objective is to review our institutional series, considering the impacts of various complexity features, and provide a treatment strategy algorithm. Methods: We conducted a retrospective review of our institutional experience with "complex MCA" aneurysms and analyzed single aneurysmal-related factors influencing treatment decisions. Results: We identified 14 complex cases, each exhibiting at least two complexity criteria, including fusiform shape (57%), large size (35%), giant size (21%), vessel branching from the sac (50%), intrasaccular thrombi (35%), and previous clipping/coiling (14%). In 92% of cases, the aneurysm had a wide neck, and 28% exhibited tortuosity or stenosis of proximal vessels. Conclusions: The optimal management of complex MCA aneurysms depends on a decision-making algorithm that considers various complexity criteria. In a modern medical setting, this process helps clarify the choice of treatment strategy, which should be tailored to factors such as aneurysm morphology and patient characteristics, including a combination of endovascular and surgical techniques.
KW - complex aneurysms
KW - complexity criteria
KW - endovascular treatment
KW - unruptured
KW - middle cerebral artery
KW - surgical clipping
KW - treatment algorithm
KW - intracranial aneurysms
KW - complex aneurysms
KW - complexity criteria
KW - endovascular treatment
KW - unruptured
KW - middle cerebral artery
KW - surgical clipping
KW - treatment algorithm
KW - intracranial aneurysms
UR - http://hdl.handle.net/10807/298901
U2 - 10.3390/jcm13051286
DO - 10.3390/jcm13051286
M3 - Article
SN - 2077-0383
VL - 13
SP - 1
EP - 9
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
ER -