Microsurgical treatment of distal aneurysms of the middle cerebral artery

The study objective is to investigate the features of distal aneurysms of the middle cerebral artery and to evaluate the results of their surgical treatment.Materials and methods. From 01/01/2000 to 12/31/2019 at the N.V. Sklifosovsky Research Institute of Emergency Medicine, 37 patients with distal SMA aneurysms were operated (21 women, 16 men, the average age of 48 y. o). SMA aneurysms were classified by their localization according to the classification of H. Gibo. The aneurysms of the M2 segment of the MCA were encountered more often (56.8 %). 28 aneurysms had a saccular structure, 9 (24.3 %) had a fusiform. The size of the saccular aneurysms ranged from 1.4 to 34.0 mm. More than 65 % of patients had aneurysms of 7 mm or less.Results. The surgical access was selected depending on the location of the MCA aneurysm. The pterional transsylvian access is used more often, less often - with aneurysms of the M4-segment, convexital trepanation. The reconstructive clipping of the distal SMA aneurysm was performed in 22 (59.4 %) cases, trapping and/or excision in 15 (40.5 %) cases. After the deconstructive intervention, revascularization was performed on 6 (16 %) patients.Conclusion. Distal aneurysms of the middle cerebral artery are a rare pathology that requires an individual approach -contact Doppler ultrasound or intraoperative angiography, intraoperative neuromonitoring, as well as, if necessary, the use of revascularization methods. To optimize surgical access, it is preferable to use neuronavigation.