Focused opening of the sylvian fissure for microsurgical management of MCA aneurysms

Abstract

The focused sylvian opening is a less-invasive alternative to the classical wide sylvian opening for the microsurgical management of most MCA aneurysms.

Venous-Preserving Sylvian Dissection

“…We usually split the lateral sylvian fissure widely in a distal (lateral-to-medial) fashion, even for deep lesions around the basal cisterns, but we believe that at least a part of this technique can be applied to the proximal (medial-to-lateral) transsylvian approach or an approach with a small sylvian opening. [3] Between April 2011 and March 2015, we operated 66 unruptured middle cerebral and internal carotid artery aneurysms (40 and 26, respectively). We reviewed the operative reports and videos whether we could split the sylvian fissure completely (as far as we needed).…”

“…Sylvian dissection is one of the requisite skills for microneurosurgeons, since the transsylvian approach combined with frontotemporal craniotomy and its modifications are one of the most versatile and commonly performed approaches. [3,6,7,13,19] The superficial sylvian veins, one of the three dominant venous drainage systems of the lateral cerebrum, lie on the surface of the sylvian fissure. They usually drain into the dural sinus along the sphenoid wing.…”

Short-Burst Bipolar Coagulation for Repairing Partially Damaged Brain Arteries Preserving Their Flow: Technical Note

“…Temporary clips are not used regularly, but sometimes a small pledged may be useful. The adjustment of the strength of the suction usually allows to control the bleeding in most of the cases ( Figure 3) (13,16,17).…”

Transsylvian and paratransylvian approach at non-traumatic intracerebral hematomas of cerebral hemispheres (microanatomic justification and clinical observations)

“…У большинства больных нарушение кровообраще-ния ГМ происходит именно в бассейне СМА, поэтому понятен интерес к изучению микрохирургической анатомии БЦ и СМА [4][5][6][7][8][9][10][11][12][13][14][15][16]. Однако анатомические особенности боковой борозды и БЦ применительно к трансильвиевому и трансинсулярному доступу не-достаточно изучены.…”

“…Такое деление способствует уменьшению операционной травмы и облегчает микрохирургическое удаление НВМГ [8], другие [16] -для микрохирургического клиппирования аневризм СМА используют фокус-ные (сегментарное вскрытие БЦ) транссильвиевые доступы, что уменьшает инвазивность операции по сравнению с таковой при использовании обще-принятой техники. Применяют и стереотаксический Рис.…”