| Titre : | MCA ANEURYSMS: CLIP FIRST POLICY SINGLE INSTITUTIONAL EXPERIENCE | | Type de document : | thèse | | Auteurs : | MRICHI Salma, Auteur | | Langues : | Français (fre) | | Mots-clés : | Middle Cerebral Artery Aneurysms Clip Endovascular Therapy | | Résumé : | Keywords: Middle Cerebral Artery Aneurysms, Clip, Endovascular Therapy
Introduction:
Management strategies for intracranial aneurysms have changed dramatically over the past decades.
Both with the publication of the International Subarachnoid Aneurysm Trial (ISAT) and the
improvement of endovascular techniques, centers have been increasingly adopting endovascular
treatment as the primary procedure. Unfortunately, ISAT did not focus on patients with middle
cerebral artery aneurysms and optimal treatment modalities are still controversial. However,
microsurgical treatment remains well established as the preferred strategy for definitive obliteration of
MCA aneurysms.
Objective:
Review of clip first policy in management of MCA aneurysm at Hôpital des Spécialités CHU Rabat
from January 2015 to December 2021.
Patients and methods:
We performed a retrospective study of patients managed at our center from January 2015 to December
2021. This analysis included 42 patients with ruptured and unruptured MCA aneurysms treated by the
same leading neurosurgeon at the Department of neurosurgery of Hôpital des Spécialités, University
of Medicine of Rabat, Morocco. Patients’ characteristics and presentation, aneurysms morphology and
number were gathered. Chosen management modalities and the patients neurological and radiological
outcomes were studied.
Results
Age range was 6 to 88 years with mean age of 47 years. Average interval between the onset of
symptoms and the time of consultation was 15 days (1-22 days). At admission 21 patients were grade I
of WFNS scale (50%), 9 were grade II and III (21,4%), and 3 were grade IV (7,1%). Motor deficit was
present in14 cases (33,3%). Only 3 patients presented epilepsy at admission (7,1%). Four patients
suffered from multiple aneurysms (11,1%), either bilateral sylvian aneurysms or any other
localization. Wide-necked aneurysm accounted for 57%. Mean size of maximum diameter of
aneurysm was 7,6mm (range 2-26,6mm). Microsurgical clipping was the first-choice treatment as
81% of patients were operated (eight of whom received treatment within 72 hours). Only 1 patient
received endovascular treatment. In postoperative period, 50% of patients were mRS 0 and we noted
26,2% death mainly due to vasospasm.
Conclusion
The rise of endovascular procedures has led to a significant decline of the surgical caseload.
Nevertheless, surgery should remain the treatment of choice for MCA aneurysms when endovascular
management should be considered as alternative therapy. | | Numéro (Thèse ou Mémoire) : | MS0522022 | | Directeur : | Abdessamad El Ouahabi |
MCA ANEURYSMS: CLIP FIRST POLICY SINGLE INSTITUTIONAL EXPERIENCE [thèse] / MRICHI Salma, Auteur . - [s.d.]. Langues : Français ( fre) | Mots-clés : | Middle Cerebral Artery Aneurysms Clip Endovascular Therapy | | Résumé : | Keywords: Middle Cerebral Artery Aneurysms, Clip, Endovascular Therapy
Introduction:
Management strategies for intracranial aneurysms have changed dramatically over the past decades.
Both with the publication of the International Subarachnoid Aneurysm Trial (ISAT) and the
improvement of endovascular techniques, centers have been increasingly adopting endovascular
treatment as the primary procedure. Unfortunately, ISAT did not focus on patients with middle
cerebral artery aneurysms and optimal treatment modalities are still controversial. However,
microsurgical treatment remains well established as the preferred strategy for definitive obliteration of
MCA aneurysms.
Objective:
Review of clip first policy in management of MCA aneurysm at Hôpital des Spécialités CHU Rabat
from January 2015 to December 2021.
Patients and methods:
We performed a retrospective study of patients managed at our center from January 2015 to December
2021. This analysis included 42 patients with ruptured and unruptured MCA aneurysms treated by the
same leading neurosurgeon at the Department of neurosurgery of Hôpital des Spécialités, University
of Medicine of Rabat, Morocco. Patients’ characteristics and presentation, aneurysms morphology and
number were gathered. Chosen management modalities and the patients neurological and radiological
outcomes were studied.
Results
Age range was 6 to 88 years with mean age of 47 years. Average interval between the onset of
symptoms and the time of consultation was 15 days (1-22 days). At admission 21 patients were grade I
of WFNS scale (50%), 9 were grade II and III (21,4%), and 3 were grade IV (7,1%). Motor deficit was
present in14 cases (33,3%). Only 3 patients presented epilepsy at admission (7,1%). Four patients
suffered from multiple aneurysms (11,1%), either bilateral sylvian aneurysms or any other
localization. Wide-necked aneurysm accounted for 57%. Mean size of maximum diameter of
aneurysm was 7,6mm (range 2-26,6mm). Microsurgical clipping was the first-choice treatment as
81% of patients were operated (eight of whom received treatment within 72 hours). Only 1 patient
received endovascular treatment. In postoperative period, 50% of patients were mRS 0 and we noted
26,2% death mainly due to vasospasm.
Conclusion
The rise of endovascular procedures has led to a significant decline of the surgical caseload.
Nevertheless, surgery should remain the treatment of choice for MCA aneurysms when endovascular
management should be considered as alternative therapy. | | Numéro (Thèse ou Mémoire) : | MS0522022 | | Directeur : | Abdessamad El Ouahabi |
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