Treatment Of Middle Cerebral Artery Aneurysm:Endovascular Coiling Versus Microsurgical Clipping In A Single Center

Background:Middle cerebral artery aneurysm (MCAA) is a common type of cerebral aneurysms. The best treatment of MCAA is still controversial. Although most neurosurgeries consider that microsurgical clipping has its advantage according to the location of MCAA, it is still lack of researches to prove it. Recently there are more and more literatures reporting that the endovascular coiling is safe and effective for the treatment of MCAA.Objective:To compare endovascular coiling with microsurgical clipping to treat MCAA in our hospital.Methods:All the patients, diagnosed with MCAA and treated in our institution from October 2013 to October 2015,were retrospectively analyzed, including complete occlusion rate, complication and outcome after 6 months.Result:In the study,160 patients were diagnosed with MCAA and treated by endovascular coiling cohort (n=32) or microsurgical clipping cohort(n=128), including 75 (46.9%) males,85(53.1%) females. MCAAs were presented as single (73.8%), multiple (26.2%) with bilateral mirror aneurysms (6.9%). In the patient whose hunt-hess degree is under 3, complete aneurysm occlusion was achieved in 90.3% in the endovascular coiling cohort and 90.4% in the microsurgical clipping cohort after the operations. The recurrence rate after 6 months was 9.7% for endovascular coiling and 1.8% for microsurgical clipping(P<0.05). The adverse event rate was 27.2% in the microsurgical clipping cohort and 9.7% in the endovascular coiling cohort. The GOS scores of 4-5 after 6 months were obtained in 96.8% of endovascular coiling patients compared to 86.0% of microsurgical clipping patients.Conclusion:Based on our study, there is no significant difference between the two therapies in complete aneurysm occlusion after the operations and short-term outcome (at least 6 months). But endovascular coiling patients presents a higher recurrence rate and more expensive, microsurgical clipping patients may have higher adverse event rate and longer hospitalization time. Nowadays, the technology of endovascular coiling is improved rapidly. Like other new technology, the development of endovascular coiling may meet with initial resistance and problems. But endovascular coiling may have its position in the treatment of MCAA. More prospective randomized clinical trial are still needed in the future.