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Direct surgical treatment of giant middle cerebral artery aneurysms using microvascular reconstruction techniques.

Giant intracranial aneurysm is a life-threatening lesion and treatment of the aneurysm could be hazardous and complex. This study describes direct surgical treatment of giant middle cerebral artery (MCA) aneurysms using microvascular reconstruction techniques in 13 patients treated between 2006 and 2009. In all 13 patients, superficial temporal artery (STA)-MCA (M(2)) anastomosis was performed as a precaution prior to attacking the aneurysm. During surgery, microvascular reconstruction of incorporative arteries was additionally performed if the aneurysm was removed. Direct neck clipping was performed in four patients, trapping and removal of the aneurysm in one, and removal of the aneurysm with vascular reconstruction of the MCA in eight patients. Minor ischemic complications due to perforator ischemia were recognized in 6 patients, and 10 patients achieved functionally favorable outcomes (modified Rankin scale score 0 or 1). In direct surgery for giant MCA aneurysm, precautionary STA-M(2) bypass could provide appropriate surgical strategies tailored to individual cases, including direct clipping and removal of the aneurysm with or without vascular reconstruction. Microvascular reconstruction techniques are essential for complete cure of giant MCA aneurysms.