Acta Neurochirurgica

, 149:661

Characteristics and management of ruptured distal middle cerebral artery aneurysms

  • S.-P. Joo
  • T.-S. Kim
  • J.-W. Choi
  • J.-K. Lee
  • Y.-S. Kim
  • K.-S. Moon
  • J.-H. Kim
  • S.-H. Kim
Clinical Article

Summary

Objective. Distal middle cerebral artery (dMCA) aneurysms are very rare with a reported frequency of 2–6%. Typically, patients with ruptured distal MCA aneurysms have poor clinical outcomes because often there is both a subarachnoid haemorrhage (SAH) and an intracerebral haematoma (ICH). The goals of this study were to identify the characteristics of the distal MCA aneurysms and evaluate the optimal treatment for a good outcome.

Methods. The clinical, neuroradiological and operative records of 8 patients with a ruptured distal MCA aneurysm who underwent surgical management were reviewed retrospectively. The outcomes were presented according to the Glasgow Outcome Scale (GOS).

Results. The clinical characteristics of the patients with ruptured dMCA aneurysms included the following: (1) a fusiform appearance in five out of eight (63%) patients. (2) Mean aneurysm size of 9.4 mm (range 2–35 mm). (3) The location being M2 (insular segment) in three, M2-3 junction in three, and M3 (opercular segment) in two patients. (4) Brain CT images revealed both SAH and an ICH in six of eight (75%) patients with the mean size of the ICH being 10 cc (range 5–25 cc). (5) Re-bleeding occurred in four out of eight (50%) of patients. All patients underwent early surgical treatment and the procedures used for surgical repair were, clipping in five patients, trapping in two, and trapping with end-to-end bypass surgery in one patient. Clinical outcomes were poor in two patients (death) due to severe brain swelling.

Conclusions. In this study, dMCA aneurysms had a fusiform shape and a high re-bleeding rate; if ruptured, there was generally ICH and SAH. A good clinical outcome was associated with adequate control of brain swelling and early surgery to prevent re-bleeding.

Keywords: Subarachnoid haemorrhage; distal middle cerebral artery aneurysm; re-bleeding; intracerebral haematoma. 

Abbreviations

GOS

Glasgow Outcome Scale

SAH

Subarachnoid haemorrhage

ICH

Intracerebral haematoma

MCA

Middle cerebral artery

dMCA

Distal Middle cerebral artery

CT

Computerised tomography

CTA

Computed tomographic angiography

STA

Superficial temporal artery

ICP

Intracranial pressure

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • S.-P. Joo
    • 1
  • T.-S. Kim
    • 1
  • J.-W. Choi
    • 1
  • J.-K. Lee
    • 1
  • Y.-S. Kim
    • 1
  • K.-S. Moon
    • 1
  • J.-H. Kim
    • 1
  • S.-H. Kim
    • 1
  1. 1.Department of NeurosurgeryChonnam National University Hospital and Medical SchoolGwangjuKorea

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