Figure 3: Shows the preoperative (a), (b), and (c) and postoperative (d) and (e) images of the patient with a wide neck right MCA bifurcation aneurysm with both the branches originating from the neck of the aneurysm. The aneurysm has been completely occluded and both of the branches are seen filling well in the postoperative angiogram.
series of stent-assisted coil embolization of unruptured MCA aneurysms, the authors reported that about 30% of MCA aneurysms referred for potential endovascular treat- ment were found to be unsuitable because of obscuration of the aneurysm neck on 3D images by MCA branches or by more proximal vessels (M1and ICA). Another contraindi- cation to coiling was the location of the aneurysm at MCA trifurcation instead of at MCA bifurcation. 10 However, with the recent introduction of stent-assisted coiling techniques, flow-diverting stents, and the pCONus (Phenox GmbH, Bochum, Germany), there is a high possibility to overcome these anatomical difficulties which preclude endovascular therapy. 11 In our series, the intraoperative rupture (IOR) rate was 4.8%. In patients with unruptured aneurysms, IOR was encountered in only one patient (2.2%). In none of these patients was IOR associated with an adverse treat- ment outcome (P>0.05). The overall treatment-related perioperative morbidity and mortality rates were 8% and 0.8%, respectively. The morbidity associated with surgi- cal clipping of unruptured MCA aneurysms has been variously reported as being between 0.6% and 13.6%. 9,12-20 In a systematic review of endovascular therapy for MCA aneurysms, the intraprocedural rupture rate in unruptured aneurysms has been reported as being 1.7% and 4.8% for ruptured aneurysms. Morbidity due to intraprocedural rupture and thromboenbolic complications was 0% and 4.2%, respectively in unruptured aneurysms and 1.2% and 2.4% for ruptured aneurysms. The overall morbidity and
Figure 4: Shows the technique of clipping of the aneurysm, sparing the origin of both branches.
J La State Med Soc VOL 166 July/August 2014 165
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