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Microsurgical clipping of unruptured middle cerebral artery bifurcation aneurysms: incidence of and risk factors for procedure-related complications

 Joonho Chung  ;  Chang-Ki Hong  ;  Yu Shik Shim  ;  Jin-Yang Joo  ;  Yong Cheol Lim  ;  Yong Sam Shin  ;  Yong Bae Kim 
 WORLD NEUROSURGERY, Vol.83(5) : 666-672, 2015 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; Cerebral Revascularization/adverse effects ; Cerebral Revascularization/methods* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Intracranial Aneurysm/surgery* ; Male ; Middle Aged ; Middle Cerebral Artery/surgery* ; Postoperative Complications/epidemiology ; Retrospective Studies ; Risk Factors
Complications ; Intracranial aneurysm ; Microsurgical clipping ; Middle cerebral artery ; Predictors ; Unruptured aneurysm
OBJECTIVE: To report our experiences in microsurgical clipping of unruptured middle cerebral artery (MCA) bifurcation aneurysms and to evaluate the incidence of and risk factors for procedure-related complications. METHODS: The study comprised 416 patients treated between March 2003 and February 2014. All patients met the following criteria: 1) microsurgical clipping of an unruptured MCA bifurcation aneurysm was performed, and 2) clinical and radiographic follow-up data were available including preoperative digital subtraction angiography. The incidence of and risk factors for procedure-related complications were retrospectively evaluated. RESULTS: Procedure-related complications occurred in 15 (3.6%) patients, including asymptomatic complications in 10 (2.4%) patients and symptomatic complications in 5 (1.2%) patients. Multivariate logistic regression analysis showed that posteroinferior projection of the aneurysm (odds ratio = 2.814, 95% confidence interval = 0.995-6.471, P = 0.042), distance between the internal carotid artery bifurcation and the MCA bifurcation (Dt) in a linear line (odds ratio = 1.813, 95% confidence interval = 0.808-6.173, P = 0.043), and horizontal angle between the vertical line to the base of the skull and Dt (odds ratio = 2.046, 95% confidence interval = 1.048-10.822, P = 0.048) were independent risk factors for procedure-related complications. CONCLUSIONS: When performing clipping of unruptured MCA bifurcation aneurysms, the procedure-related complication rate was 3.6%. Patients with MCA bifurcation aneurysms with posteroinferior projection, shorter Dt, and larger horizontal angle may be at a higher risk of procedure-related complications when performing microsurgical clipping.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0003-2262-7157
Chung, Joon Ho(정준호)
Joo, Jin Yang(주진양)
Hong, Chang Ki(홍창기)
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