Early exposure of the dorsal surface of M1 segment via the distal transsylvian approach for clipping of anteroinferior-projecting middle cerebral artery bifurcation aneurysms

Abstract Objective: We report the technique of three-dimensional computed tomographic (CT) angiography with a two-dimensional CT image aiding in the early operation of ruptured middle cerebral artery aneurysms. This combined image allows the prediction of the rupture point in the aneurysm and may reduce the risk of rupture during early clipping surgery. Methods: The findings for 14 patients with 14 middle cerebral artery ruptured aneurysms who underwent subsequent early clipping were analyzed. The average aneurysm size was 8.5 mm, and there were two large and one giant aneurysms. CT examinations were performed by means of a multidetector CT scanner (Aquilion M16; Toshiba Medical Systems, Tokyo, Japan) and reconstructed with a workstation (ZIO M900 QUADRA; Amin Co., Ltd., Tokyo, Japan). We constructed an operating view through three-dimensional CT angiography for a lateral transsylvian approach with a two-dimensional CT image (nonshaded volume-rendering image), which was perpendicular to the direction of the surgical approach. Using this combined image, we predicted the rupture point of the aneurysm and successfully performed clipping surgery through a lateral transsylvian approach. Rupture points were confirmed at the time of surgery. Rupture points of 13 out of 14 aneurysms appeared as we expected, but one differed; all aneurysms were successfully clipped. Thirteen of the 14 patients could be clipped without rupture at surgery, but the remaining patient experienced rupture just after craniotomy. Conclusion: The combination of three-dimensional CT angiography and two-dimensional CT images may help improve the surgical outcome by indicating aneurysmal rupture points, leading to the prevention of rupture.

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Nuances of Middle Cerebral Artery Aneurysm Microsurgery

Neurosurgery ◽

10.1097/00006123-200102000-00020 ◽

2001 ◽

Vol 48 (2) ◽

pp. 339-346 ◽

Cited By ~ 7

Author(s):

Douglas Chyatte ◽

Rebecca Porterfield

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Artery Aneurysm ◽

Surgical Anatomy ◽

Surgical Approaches ◽

Common Source ◽

Transsylvian Approach ◽

Microsurgical Clipping ◽

Technical Requirements ◽

Middle Cerebral Artery Aneurysms

Abstract Middle cerebral artery aneurysms, a common source of subarachnoid hemorrhage, occur predominantly at the main bifurcation of the middle cerebral artery. Microsurgical clipping is the most effective treatment of these aneurysms because of their peripheral location, wide necks, and straightforward surgical anatomy. Despite the moderate technical requirements of this type of surgery, patients with ruptured aneurysms often have poor outcomes because of the high incidence of intracerebral hematomas. Although several different surgical approaches can be used, we favor a lateral-to-medial transsylvian approach for most aneurysms. This description of our surgical technique stresses minimizing retraction to avoid injury to the brain and preparing broad-based middle cerebral artery aneurysms for clipping. Management of outcomes when using these techniques also is presented.

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The transsylvian approach to middle cerebral artery bifurcation/trifurcation aneurysms

Surgical Neurology ◽

10.1016/0090-3019(94)90124-4 ◽

1994 ◽

Vol 41 (3) ◽

pp. 217-219 ◽

Cited By ~ 21

Author(s):

Michael B. Pritz ◽

William F. Chandler

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Transsylvian Approach

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Single fronto-temporal sylvian vein reconstruction when treating a large partially thrombosed aneurysm of the M1 middle cerebral artery

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2016-3-118-121 ◽

2016 ◽

Vol 20 (3) ◽

pp. 118

Author(s):

A V Dubovoy ◽

K S Ovsyannikov ◽

M E Amelin

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Conflict Of Interest ◽

Clinical Case ◽

Sylvian Fissure ◽

Aneurysm Neck ◽

Temporal Lobes ◽

Transsylvian Approach ◽

Thrombosed Aneurysm ◽

End To End

The article describes a clinical case of clipping the neck of large partially thrombosed aneurysm by using a transsylvian approach. A feature of the case is an atypical structure of the Sylvian fissure, with just one vein draining both the frontal and the temporal lobes and hindering access to the Sylvian fissure. The problem was solved by cutting the vein, performing the aneurysm neck clipping and suturing the cut vein by means of end-to-end technique. Received 19 April 2016. Accepted 7 September 2016.Funding: The study had no sponsorship. Conflict of interest: The authors declare no conflict of interest.

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An ultrastructural analysis of the sympathetic innervation of the rabbit ear artery and middle cerebral artery and their branches

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100125075 ◽

1992 ◽

Vol 50 (1) ◽

pp. 934-935

Author(s):

John T. Dodge ◽

John A. Bevan

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Sympathetic Innervation ◽

Electrical Field Stimulation ◽

Rabbit Ear Artery ◽

Electrical Field ◽

Functional Differences ◽

Ear Artery ◽

Rabbit Ear ◽

Vascular Beds

Unlike many peripheral vascular beds, the sympathetic nervous system exerts little control on cerebral blood flow. The contractile response of isolated rabbit middle cerebral artery (MCA) segments to electrical field stimulation of its intramural nerves is less than in a similar-sized artery from the ear. This study was undertaken to characterize and compare the perivascular neuromuscular relationships and innervation density of similar-sized arteries varying in diameter from these two different regional arterial beds to see if there were structural correlates for these functional differences.

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