الفهرس 
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Abstract
The middle cerebral artery is considered the intracranial artery with the most complex branching pattern and remains a very common site of intracranial aneurysmal formation along its various segments.
Thirty-two patients harboring 35 MCA aneurysms were studied in this series, with the purpose to evaluate the applicability, outcome and possible limitations of different therapeutic modalities/strategies used in their management.
Aneurysms of the MCA tend to be perceived as straightforward lesions due to their relative superficial location in the sylvian fissure. That said they represent a full range of surgical complexity, leading to therapeutic challenges, not uncommonly leading to complications with significant clinical consequences.
Aneurysms were categorized according to anatomical site of origin in to: proximal M1 aneurysms (22.8%), bifurcation/trifurcation aneurysms (68.5%) and distal aneurysms (3%). 10 were ruptured (28.5%) and 25 were unruptured (71.5%).
3D-DSA provided excellent image acquisition for aneurysm characterization.14 aneurysms (40%) were small in size (<5mm). 13 aneurysms (37%) were medium sized (≤5mm>10mm), 7 aneurysms (20%) were large (≤ 10mm<25mm) and one was giant in size (2.8%). 4 aneurysms had a small neck/sac ratio ≤ 0.5 (11.4%). 13 had a medium sized neck/sac ratio > 0.5 ≤ 1 (37%) and 18 had wide necks with a ratio >1 (51%)
Twenty-five patients with 28 MCA aneurysms underwent surgical clipping (80%). The remaining seven patients harbored seven aneurysms and underwent endovascular treatment (20%).
Surgical clipping was performed via a lateral supraorbital approach for unruptured aneurysms and via a pterional craniotomy for ruptured ones. The surgical group included all ruptured aneurysms. In 2 patients a decompressive hemicraniotomy was done for evacuation of an associated intraparenchymal hematoma.