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

PURPOSE: Optimal management of unruptured, middle cerebral artery (MCA) aneurysms, remains undetermined between microsurgical clipping and endovascular intervention. This study aims to compare post-operative functional outcomes between microsurgically and endovascularly treated, unruptured MCA aneurysms.

MATERIALS AND

METHODS

All cases of unruptured MCA aneurysms undergoing treatment during a 10-year time period were identified and included. Functional status (FS) was measured using the Modified Rankin Scale. FS was assessed pre-treatment and at 1-month, 6-months and 12-months post-treatment. Median FS was compared between groups and relative risk ratios (RR) calculated to compare the risk of post-operative deterioration between the microsurgical and endovascular cohort at each time point. Occlusion and retreatment rates were also compared.

RESULTS

In total, 119 cases of treated, unruptured MCA aneurysms were identified, of which 40 (34%) were managed microsurgically and 79 (66%) endovascularly. Mean age was 55 years (SD ± 11). No significant difference was seen in any demographic domain pre-operatively. 30-day survival in both cohorts was 100%. No significant difference in median FS was seen between the cohorts at any time point post-treatment. There was a significantly increased risk of deterioration in FS amongst the microsurgical cohort at 1-month post-treatment (RR 1.98, 95% CI 1.08 - 3.62, p = 0.03). There was no significant risk of deterioration in FS at either the 6-month nor 12-month time point post-treatment. Complete occlusion in the microsurgical cohort was greater than the endovascular cohort (91% vs. 66%), demonstrating a significantly reduced RR of incomplete occlusion (RR 0.25, 95% CI: 0.08 - 0.77, p = 0.02).

CONCLUSIONS

At 1-month post-treatment, the risk of a decline in FS from baseline was almost twice as great in the microsurgical cohort. However, there was no significant difference in the risk of deterioration in FS at 6-months nor 12-months post-treatment.