Introduction: Fusiform aneurysms are uncommon cerebral aneurysms that warrant different considerations from saccular aneurysms. The middle cerebral artery (MCA) is a common location for fusiform aneurysms to occur in the anterior circulation. Analyzing a group of patients with this type of aneurysm in the MCA will further elucidate the fusiform aneurysm.
Methods: We retrospectively selected fusiform aneurysm patients from patients who were treated at our hospital during the past 9 years, and we reviewed their medical charts and radiologic findings.
Results: There were 41 cases of fusiform aneurysms in the anterior circulation. Of these cases, 29 cases were in the MCA, which represented the most common site in the anterior circulation. The aneurysms tended to originate proximally on the MCA; 20 aneurysms originated in the M1 segment. Only 3 patients had acute symptom-related aneurysms, such as hemorrhage or ischemia, and all of the other patients were asymptomatic. Twenty-two patients without symptoms were observed by periodic imaging work-up. Among these patients, the size of 17 patient’s’ aneurysms did not change and showed no neurologic symptoms during long-term follow-up.
Conclusions: Fusiform aneurysms in the MCA are rare and are distinct in nature from saccular aneurysms. Fusiform aneurysms in the MCA tend to be located in the M1. The MCA fusiform aneurysms without acute symptoms in our study did not change size, and no hemorrhages or ischemic symptoms were noted during the long-term follow-up period.
Patient Care: The natural course of asymptomatic fusiform aneurysms in the MCA remains unclear; thus controversy about the decision to treat asymptomatic fusiform aneurysm patients persists. Our results will be helpful in determining the treatment of asymptomatic fusiform aneurysms in the MCA. We believe that MCA fusiform aneurysms without acute symptoms will be stable over a long-term period and that operative treatment may be not necessary.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the natural history and characteristics of fusiform aneurysm in MCA.
2) Discuss, in small groups, what is effective treatment method of MCA fusiform aneurysm with acute symptom
3) Identify an effective treatment of MCA fusiform aneurysm without acute symptom as periodic follow up.