Middle cerebral artery aneurysms: aneurysm angiographic morphology and its relation to pre-operative and intra-operative rupture

ABSTRACT

Objective

Correlate the middle cerebral artery bifurcation aneurysm morphology with the pre-operative and intra-operative risk of rupture.

Methods

Forty patients with 46 middle cerebral artery bifurcation aneurysms were treated microsurgically by the same surgeon. Aneurysms were classified according to shape and the Fisher test was applied to analyze the effect of morphology on the pre-operative and intra-operative rupture.

Results

Pre-operative and intra-operative ruptures were observed in 8/46 patients (17.4%) and 14/46 patients (30.4%) respectively. Thirty-two cases (69.6%) had no symptoms postoperatively, modified Rankin score (MRS) of 0; 6.5% had MRS of 1 (no significant disability); 13% had MRS of 2 (slight disability); 4.3% had moderately severe disability (MRS of 4); and there were 3 deaths (6.5%) post-operatively. The morphology was not directly related to the rupture rate.

Conclusion

In general, ruptures are not affected by the morphology or the studied variables. Larger series are needed to validate these outcomes.

RESUMO

Objetivo

Correlacionar a morfologia do aneurisma da bifurcação da artéria cerebral média com o risco de ruptura pré-operatória e intra-operatória.

Métodos

40 pacientes com 46 aneurismas de bifurcação da artéria cerebral média receberam tratamento microcirúrgico pelo mesmo cirurgião. Os aneurismas foram classificados de acordo com a morfologia e o teste de Fisher foi aplicado para analisar o efeito da morfologia sobre a ruptura pré-operatória e intra-operatória.

Resultados

As rupturas pré e intra-operatória foram observadas em 8/46 pacientes (17,4%) e 14/46 (30,4%) respectivamente. Trinta e dois casos (69,6%) não apresentaram sintomas pós-operatórios, pontuação de Rankin modificada (MRS) de 0, 6,5% tinham MRS de 1 (sem incapacidade significativa), 13% tinham MRS de 2 (leve incapacidade), 4,3% moderadamente grave (MRS de 4) e houve 3 óbitos (6,5%) durante o pós-operatório. A morfologia não estava diretamente relacionada à taxa de ruptura pré-operatória ou intra-operatória.

Conclusão

Em geral, as rupturas não são afetadas pela morfologia ou pelas variáveis estudadas. São necessárias séries maiores para validar esses resultados.

aneurysm - subarachnoid hemorrhage - middle cerebral artery

aneurisma - hemorragia subaracnoidea - artéria cerebral média

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