BACKGROUND AND OBJECTIVE: The main challenge of bypass surgery of complex MCA aneurysms is not the selection of the bypass type but the initial decision-making of how to exclude the affected vessel segment from circulation. To this end, we have previously proposed a classification for complex MCA aneurysms based on the preoperative angiography. The current study aimed to validate this new classification and assess its diagnostic reliability using the giant aneurysm registry as an independent data set. METHODS: We reviewed the pretreatment neuroimaging of 51 patients with giant (> 2.5 cm) MCA aneurysms from 18 centers, prospectively entered into the international giant aneurysm registry. We classified the aneurysms according to our previously proposed Berlin classification for complex MCA aneurysms. To test for interrater diagnostic reliability, the data set was reviewed by four independent observers. RESULTS: We were able to classify all 51 aneurysms according to the Berlin classification for complex MCA aneurysms. Eight percent of the aneurysm were classified as type 1a, 14% as type 1b, 14% as type 2a, 24% as type 2b, 33% as type 2c, and 8% as type 3. The interrater reliability was moderate with Fleiss's Kappa of 0.419. CONCLUSION: The recently published Berlin classification for complex MCA aneurysms showed diagnostic reliability, independent of the observer when applied to the MCA aneurysms of the international giant aneurysm registry.

Brandenburg Medical School Theodor Fontane Campus Bad Saarow Germany

Department of Neurosurgery and Center for Stroke Research Berlin Charité Universitätsmedizin Berlin Charitéplatz 1 10117 Berlin Germany

Department of Neurosurgery Georg August University Goettingen Göttingen Germany

Department of Neurosurgery Hannover Medical School Hannover Germany

Department of Neurosurgery Helios Clinic Bad Saarow Germany

Department of Neurosurgery J E Purkinje University Masaryk Hospital Ústí nad Labem Czech Republic

Department of Neurosurgery Jikei University School of Medicine Tokyo Japan

Department of Neurosurgery Kantonsspital Aarau Aarau Switzerland

Department of Neurosurgery Klinikum Stuttgart Germany

Department of Neurosurgery Medical Center Saarbrücken Saarbrücken Germany

Department of Neurosurgery Medical University Vienna Austria

Department of Neurosurgery Technical University of Munich Munich Germany

Department of Neurosurgery Unfallkrankenhaus Berlin Germany

Department of Neurosurgery University Hospital Bonn Bonn Germany

Department of Neurosurgery University Hospital Jena Jena Germany

Department of Neurosurgery University Hospital of Ulm Ulm Germany

Department of Neurosurgery University Hospital of Zurich Zürich Switzerland

Department of Neurosurgery University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Neurosurgery University of Essen Duisburg Germany

Department of Neurosurgery University of Regensburg Regensburg Germany

Department of Neurosurgery Vivantes Klinikum im Friedrichshain Berlin Germany

Erasmus Stroke Center Erasmus MC University Hospital Rotterdam The Netherlands

Interventional Neuroradiology and Endovascular Neurosurgery at Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute Miami USA

Neurosurgery University of Helsinki and Helsinki University Hospital Helsinki Finland

Service de Neurochirurgie Faculté de Médecine de Genève and Hôpitaux Universitaire de Genève Geneva Switzerland

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