Evaluation of surgical technique on outcomes from ruptured aneurysms of the middle cerebral artery.

OBJECTIVE: To determine the effect of surgical technique on outcomes from ruptured middle cerebral artery aneurysms (RMCAA).

METHODS: A retrospective review was performed of patients with RMCAA, who were treated at the authors' institutions. The study compares the clipping efficacy, the postoperative CT findings as well as the clinical outcome in 87 acute operated patients. Forty patients who underwent a surgical adapted technique to the preoperative radiological findings in the last 2 ½ years were included in Group 1, and 47 previously operated cases who underwent a standardized pterional approach with aneurysm preparation from proximal to distal were included in Group 2.

RESULTS: Angiographically assessed clip efficacy confirmed aneurysm occlusion in 87.5% of the patients in Group 1 and in 70.2% for Group 2 (p < 0.05). In 13 cases (32.2%) of Group 1 versus 27 cases (57.4%) of Group 2, postoperative CT scan showed hypodense brain areas (p < 0.05). In 2 cases of Group 1 versus 8 cases of Group 2, a residual haematoma was found. Three months after bleeding, 25 cases in Group 1 showed a good recovery, 10 a moderate disability, and 5 severe disability or death. In Group 2, 26 patients showed a good recovery, 9 a moderate disability, and 12 severe disability or death. There was a difference for patients with severe disability/death between both groups (p < 0.001).

CONCLUSION: Individually adapted surgical technique in patients with RMCAA improves the efficacy of aneurysm clipping and clot removal, reduces postoperative hypodense brain areas and improves the patients' outcome.