Aneurysms of the Middle Cerebral Artery

  • Hans-Jakob Steiger
  • Nima Etminan
  • Daniel Hänggi


Middle cerebral artery (MCA) aneurysms are fairly peripheral to the arterial tree, occurring close to the cranial surface. They are often broad based and rarely lead to a hematoma in the temporal lobe or Sylvian fissure. (Compare also Sect. 7.2.) These factors are in favor of the microsurgical approach, although many MCA aneurysms can technically also be controlled with modern endovascular systems.

The location and projection of the aneurysms is important for approach planning. As outlined earlier, we prefer a tailored transsylvian approach in which the M2 segments are identified first and then followed backward to the bifurcation and the neck of the aneurysm.


Middle Cerebral Artery Decompressive Craniectomy Sylvian Fissure Middle Cerebral Artery Aneurysm Bifurcation Aneurysm 
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  1. 1.
    Brinjikji W, Lanzino G, Cloft HJ, Rabinstein A, Kallmes DF. Endovascular treatment of middle cerebral artery aneurysms: a systematic review and single-center series. Neurosurgery. 2011;68:397–402.CrossRefPubMedGoogle Scholar
  2. 2.
    Rodríguez-Hernández A, Sughrue ME, Akhavan S, Habdank-Kolaczkowski J, Lawton MT. Current management of middle cerebral artery aneurysms: surgical results with a “clip first” policy. Neurosurgery. 2013;72:415–27.CrossRefPubMedGoogle Scholar
  3. 3.
    Heros RC, Ojemann RG, Crowell RM. Superior temporal gyrus approach to middle cerebral artery aneurysms: technique and results. Neurosurgery. 1982;10:308–13.CrossRefPubMedGoogle Scholar
  4. 4.
    Ogilvy CS, Crowell RM, Heros RC. Surgical management of middle cerebral artery aneurysms: experience with transsylvian and superior temporal gyrus approaches. Surg Neurol. 1995;43:15–22; discussion 22–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Ulm AJ, Fautheree GL, Tanriover N, Russo A, Albanese E, Rhoton Jr AL, et al. Microsurgical and angiographic anatomy of middle cerebral artery aneurysms: prevalence and significance of early branch aneurysms. Neurosurgery. 2008;62(5 Suppl 2):ONS344–52.PubMedGoogle Scholar
  6. 6.
    Ha SK, Lim DJ, Kang SH, Kim SH, Park JY, Chung YG. Analysis of multiple factors affecting surgical outcomes of proximal middle cerebral artery aneurysms. Clin Neurol Neurosurg. 2011;113:362–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Paulo MS, Edgardo S, Fernando M, Pablo P, Alejandro T, Verónica V. Aneurysms of the middle cerebral artery proximal segment (M1). Anatomical and therapeutic considerations. Revision of a series. Analysis of a series of the pre bifurcation segment aneurysms. Asian J Neurosurg. 2010;5:57–63.PubMedCentralPubMedGoogle Scholar
  8. 8.
    Tapaninaho A, Hernesniemi J, Vapalahti M. Emergency treatment of cerebral aneurysms with large haematomas. Acta Neurochir (Wien). 1988; 91:21–4.CrossRefGoogle Scholar
  9. 9.
    Otani N, Takasato Y, Masaoka H, Hayakawa T, Yoshino Y, Yatsushige H, et al. Surgical outcome following decompressive craniectomy for poor-grade aneurysmal subarachnoid hemorrhage in patients with associated massive intracerebral or Sylvian hematomas. Cerebrovasc Dis. 2008;26:612–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Bohnstedt BN, Nguyen HS, Kulwin CG, Shoja MM, Helbig GM, Leipzig TJ, et al. Outcomes for clip ligation and hematoma evacuation associated with 102 patients with ruptured middle cerebral artery aneurysms. World Neurosurg. 2013;80:335–41.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Hans-Jakob Steiger
    • 1
  • Nima Etminan
    • 1
  • Daniel Hänggi
    • 1
    • 2
  1. 1.Neurochirurgische KlinikUniversitätsklinikum DüsseldorfDüsseldorfGermany
  2. 2.Medical Art Christine Opfermann-RüngelerZentrum für Anatomie Heinrich Heine UniversitätDüsseldorfGermany

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