1043. Clinical and angiographic outcome of fusiform middle cerebral artery aneurysms (33 cases): observation VS surgical treatment

Authors: Jae Seung Bang, MD; Dongwook Seo; Si Un Lee; Chang Wan Oh; O-Ki Kwon; Seong Pil Ban; Tackeun Kim; Seung Hoon Kim (Seoul, Republic of Korea)

Instruction> There are few reports on the natural history of fusiform middle cerebral artery (MCA) aneurysms and the outcome of surgery. Methods> from 2003 to 2017, thirty three patients were divided into observation group and operation group. The authors retrospectively reviewed the presentation, location, and shape of the aneurysm; the microsurgical technique; clinical and angiographic outcome. Results> Seventeen patients who presented subarachnoid hemorrhage (SAH) or have aneurysm with bleb change or eccentric aneurysmal shape were underwent surgery. The remaining 16 patients were included in observation group. Thirteen of 16 patients in observation group did not have bleb changes on the aneurysms and three patients in observation group, who have blebs on the aneurysms, could not have surgery due to the risk of occlusion of M1 perforators. In observation group, during follow-up period of 69.9 ± 39.8 months, there was no hemorrhage. Increased size of aneurysm were observed in five patients, but the increase of size occurred within 48 months and there was no increase in follow-up period thereafter. Neither of the age, aneurysm size, underlying disease, presence of stenosis, bleb or thrombus was a statistically significant risk factor for increase of aneurysm size. But,one of five patients developed infarction due to an increased thrombus in the aneurysm. In operation group, most of patients underwent bypass with trapping and clinical outcome of postoperative six months were favorable. Conclusion> Clinical course of fusiform MCA aneurysm without bleb change was supposed to be benign. Though, the patient with intra-aneurysmal thrombus and small fusiform aneurysm need to be observed cautiously. On the other hands, if surgery is necessary, surgical treatment may be considered because of the favorable outcome of surgery.