Functional outcomes following treatment of unruptured middle cerebral artery aneurysms: a single-centre comparison of microsurgical vs. endovascular management

Area of Science:

• Neurosurgery
• Vascular Neurology
• Interventional Neuroradiology

Background:

• Optimal management for unruptured middle cerebral artery (MCA) aneurysms is debated.
• Microsurgical clipping and endovascular intervention are primary treatment options.
• Comparing functional outcomes is crucial for treatment selection.

Purpose of the Study:

• To compare post-operative functional outcomes between microsurgical clipping and endovascular intervention for unruptured MCA aneurysms.
• To evaluate functional status using the Modified Rankin Scale at various time points.
• To assess occlusion and retreatment rates for both treatment modalities.

Main Methods:

• Retrospective analysis of 119 unruptured MCA aneurysm cases over 10 years.
• Functional status (FS) assessed pre-treatment and at 1, 6, and 12 months post-treatment.
• Comparison of median FS and calculation of relative risk ratios (RR) for functional deterioration.

Main Results:

• No significant difference in median FS between microsurgical and endovascular cohorts at any post-treatment time point.
• Increased risk of FS deterioration in the microsurgical cohort at 1 month (RR 1.98).
• Microsurgery demonstrated higher complete occlusion rates (91% vs. 66%) with reduced risk of incomplete occlusion (RR 0.25).

Conclusions:

• While microsurgery for MCA aneurysms carries a higher short-term risk of functional decline, long-term functional outcomes are comparable to endovascular treatment.
• Microsurgical clipping offers superior aneurysm occlusion rates.
• Treatment choice should consider the balance between short-term risks and long-term occlusion efficacy.