{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T14:47:58Z","timestamp":1777128478576,"version":"3.51.4"},"reference-count":28,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground: <\/jats:title>\nThe management choice for the middle cerebral artery aneurysms (MCAAs) is still controversial. This review aims to describe a single-center \u201cclipping first\u201d policy for MCAA over 40 years of experience and compare the short- and long-term clinical outcomes by aneurysm\u2019s location.<\/jats:p>\n<\/jats:sec>\n\nMethods: <\/jats:title>\nThis retrospective cohort study reviews the whole series of a single-center intracranial aneurysm mainly based on the micro-neurosurgical experience of the senior authors (EOA and EKA). More than 968 aneurysm patients were treated at the University Hospital \u201cH\u00f4pital des Sp\u00e9cialit\u00e9s\u201d Ibn Sina of Rabat in Morocco since 1983. We have included aneurysmal subarachnoid hemorrhage patients with the World Federation of Neurosurgical Societies (WFNS) Grade \u2264III (64.7% clipped; 6.9% coiled) and those with WFNS Grade \u2265IV (27.5% clipped; 0.9% coiled).<\/jats:p>\n<\/jats:sec>\n\nResults: <\/jats:title>\nFrom the database of 1069 IAs in 968 patients, we depicted 218 (22.5%) patients carrying 279 (26.1%) MCAA. About 92.1% (n<\/jats:italic> = 257) of the MCAAs were microsurgically clipped, and 96.3% (n<\/jats:italic> = 210) were discharged with good outcomes (modified Rankin Scale [mRS] \u22642). In the post hoc<\/jats:italic> test, the mean of intracerebral hemorrhage (ICH) (4.178) among the group of poor outcome patients (mRS >2) was significantly (P<\/jats:italic> = 0.001) high compared to that of 0.827 good outcome patients (mRS \u22642). The negative correlation found between the dome\/neck ratio and the mRS (Pearson\u2019s r = \u22120.023, 95%confidence interval [CI] 0.110\u2013\u22120.156) at admission (Pearson\u2019s r = \u22120.073, 95%CI 0.061\u2013\u22120.204) and at discharge confirmed that the wider the MCAA neck is, the more susceptible it is to have a poor prognosis.<\/jats:p>\n<\/jats:sec>\n\nConclusion: <\/jats:title>\nThe good clinical outcome from the microsurgically clipped patients is overwhelming and allows us to conclude that microsurgical treatment should be mostly considered for MCAA management. The patient\u2019s poor outcome with MCAA at discharge was significantly associated with ICH at admission in the frequency of 68.9%.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_756_2024","type":"journal-article","created":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T11:01:12Z","timestamp":1735297272000},"page":"474","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clipping first policy for middle cerebral artery aneurysm: A single-center cohort study"],"prefix":"10.25259","volume":"15","author":[{"given":"Yao Christian Hugues","family":"Dokponou","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed 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