Clipping Versus Coiling for Ruptured Middle Cerebral Artery Aneurysms

Background: Middle cerebral artery (MCA) aneurysms have been considered very well accessible for surgical treatment. Recent technology has led to successful endovascular treatment of MCA aneurysms. OBJECTIVE: The aim of this study is to analyze the outcome of surgical versus endovascular treatment of MCA aneurysms. Patients AND Methods: A retrospective analysis was done on twenty two patients with ruptured MCA aneurysms who were treated between June 2011 and June 2015 at the Neurosurgery Department and Neuro-intervention Unit of Radiology Department, Faculty of Medicine, Cairo University. They were divided into 2 groups: surgical clipping (twelve patients) and endovascular coiling (ten patients). Outcome was based on complications, clinical outcome, and retreatment rates. Results: Procedure-related complications were 8.3% and 20% for the clipping and coiling groups, respectively. Patients with good clinical outcome at 6 months follow-up were 75% and 70% for the clipping and coiling groups, respectively. The mean angiographic follow-up was 9.2 months. Retreatment rates were 8.3% and 30% for the clipping and coiling groups respectively. Conclusions: Clipping and coiling for ruptured MCA aneurysms have comparable clinical outcome but coiling has higher complication and retreatment rates so surgical clipping is recommended as the principal treatment strategy for MCA aneurysms. However, appropriate patient selection is extremely important to optimize the outcomes.