Institute of Neurosurgery, Catholic University School of Medicine, L.go A. Gemelli 8, 00168, Rome, Italy.
Neurosurg Rev. 2019 Sep;42(3):649-661. doi: 10.1007/s10143-018-0984-7. Epub 2018 May 22.
Thrombosed aneurysms of the middle cerebral artery (MCA) usually show large dimension and complex morphology with neck sclerosis and perforating vessels originating from the sac. Only limited experiences from case reports or small mixed series including thrombosed aneurysms in different locations are available in literature. To systematically review all the pertinent literature, a comprehensive literature review with the search terms "MCA, aneurysm, and thrombosis" and a pooled analysis including our institutional series were performed. We evaluated demographics, ruptured status, aneurysm morphology, topography and size, thrombosis extension, treatment, complications, final occlusion rate, and clinical outcome at follow-up. Data were individually extracted for each patient and included in a pool for the statistical analysis. Forty-two articles published between 1992 and 2016 were selected, including a total of 115 patients. Most of thrombosed aneurysms were saccular (67.6%), large or giant (86.7%), and located at the MCA bifurcation (67.3%). The treatment of choice was surgery in more than 80% of cases compared with the endovascular techniques, though the overall percentage of complications reported in the two groups was similar and around 20% of cases. Clinical outcome was favorable in more than 85% of patients after treatment. This is the first systematic review focusing on treatment and outcome of thrombosed MCA aneurysms. Our data depict their main angioarchictectural and clinical characteristics, proving the feasibility of their treatment with good prognosis in a high percentage of patients. However, complication and mortality rates of about 20 and 3.5%, respectively, are not negligible.
大脑中动脉（MCA）血栓形成的动脉瘤通常表现为大尺寸和复杂形态，伴有颈部硬化和起源于瘤囊的穿支血管。文献中仅有有限的来自病例报告或小混合系列的经验，包括不同部位的血栓形成动脉瘤。为了系统地回顾所有相关文献，我们使用搜索词“MCA、动脉瘤和血栓形成”进行了全面的文献回顾，并进行了包括我们机构系列在内的汇总分析。我们评估了人口统计学、破裂状态、动脉瘤形态、拓扑和大小、血栓延伸、治疗、并发症、最终闭塞率和随访时的临床结果。从每位患者中单独提取数据并纳入统计分析的池。共选择了 1992 年至 2016 年期间发表的 42 篇文章，其中包括 115 例患者。大多数血栓形成的动脉瘤是囊状（67.6%）、大型或巨大型（86.7%），位于 MCA 分叉处（67.3%）。与血管内技术相比，手术是超过 80%病例的首选治疗方法，尽管两组报告的并发症总比例相似，约为 20%的病例。治疗后，超过 85%的患者临床结果良好。这是首次针对血栓形成的 MCA 动脉瘤的治疗和结果进行的系统综述。我们的数据描绘了它们主要的血管解剖学和临床特征，证明了其治疗的可行性，在高比例的患者中具有良好的预后。然而，并发症和死亡率分别约为 20%和 3.5%，不容忽视。
