Middle Cerebral Artery Aneurysm “Neck Overhang”: Decreased Postclipping Residual Using the Intersecting Clipping Technique

Dimitriadis, Stavros I.; Qeadan, Fares; Taylor, Christopher L.; Yonas, Howard; Carlson, Andrew P.

doi:10.1093/ons/opx278

Cited by 3 publications

(5 citation statements)

References 42 publications

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“…2I and 3 ). 13 14 15 The patency of M1 and both M1 were confirmed using a micro-Doppler and indocyanine green.…”

Section: Methodsmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

“…With the use of DTSA in the current study, authors used two retractor blades for the frontal and temporal lobe retraction in the intrasylvian retraction manner, and retractor blades were applied as the brain holder after a wide dissection of the Sylvian fissure; therefore, the risk of premature rupture was minimized and the wide operative field provided the sufficient area for the ideal closure line clipping that needs various directions of the aneurysm clip application. [13][14][15] For the MCAB aneurysm that projects anteroinferiorly, the course of M1 segment usually curves superoposteriorly into the deep part of the Sylvian fissure and the frontal and temporal operculum that form the superficial part of the Sylvian fissure usually adhere tightly. 2 With the DTSA, the middle part of M1 segment, which usually locates in the deep area of the Sylvian fissure, was not required; therefore, brain injury due to extensive Sylvian fissure dissection can be avoided.…”

Section: Advantages and Special Considerations Of The Dtsamentioning

confidence: 99%

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Early Exposure of the Dorsal Surface of M1 Segment via the Distal Transsylvian Approach for Clipping of Anteroinferior-Projecting Middle Cerebral Artery Bifurcation Aneurysms

2022

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Background Middle cerebral artery bifurcation (MCAB) aneurysms are common intracranial aneurysms. Anteroinferior-projecting MCAB aneurysms, with M1 segment usually embedded into the deep part of the Sylvian fissure, cause some surgical challenges. The distal transsylvian approach (DTSA) allows M1 exposure from the dorsal surface for proximal control in the early step. Therefore, this study aimed to demonstrate the efficacy and safety of DTSA for clipping anteroinferior-projecting MCAB aneurysms. Methods Among 97 patients with MCA aneurysms, 13 with anteroinferior-projecting MCAB aneurysms who underwent aneurysm clipping via the DTSA between June 2018 and January 2021 were retrospectively evaluated for the aneurysm obliteration rate, surgical complications, and outcomes. Results Ten patients (76.9%) had ruptured MCAB aneurysms and three (23.1%) had incidentally discovered unruptured MCAB aneurysms. Favorable outcome was achieved in 100% of patients with good grade. The complete aneurysm obliteration rate was 100% without intraoperative lenticulostriate artery injury. Twelve (92.3%) patients had early identified distal M1 segment for proximal control, and one (7.7%) patient had premature rupture of aneurysm that achieved favorable outcome at 3 months postoperatively. Difficult M1 exposure and premature rupture occurred in the patient with MCAB located above the Sylvian fissure line. Permanent postoperative neurological deficit was detected in one patient due to severe vasospasm. Conclusion DTSA, which simplify the early exposure of the dorsal surface of distal M1, is safe and effective for clipping anteroinferior-projecting MCAB aneurysms without extensive Sylvian fissure dissection. High-positioned MCAB requires careful dissection of the aneurysm neck with consideration of tentative clipping preparation.

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“…2I and 3 ). 13 14 15 The patency of M1 and both M1 were confirmed using a micro-Doppler and indocyanine green.…”

Section: Methodsmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Advantages and Special Considerations Of The Dtsamentioning

confidence: 99%

See 1 more Smart Citation

Early Exposure of the Dorsal Surface of M1 Segment via the Distal Transsylvian Approach for Clipping of Anteroinferior-Projecting Middle Cerebral Artery Bifurcation Aneurysms

2022

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“…After the proximal control at the distal M1 from the dorsal side, the definite clipping of the aneurysm neck should be placed at the ideal closure line [Figures 2i and 3]. [13][14][15] The patency of M1 and both M1 were confirmed using a micro-Doppler and indocyanine green.…”

Section: Operative Techniques For Distal Transsylvian Approachmentioning

confidence: 99%

“…With the use of DTSA in the current study, authors used two retractor blades for the frontal and temporal lobe retraction in the intrasylvian retraction manner, and retractor blades were applied as the brain holder after a wide dissection of the Sylvian fissure; therefore, the risk of premature rupture was minimized and the wide operative field provided the sufficient area for the ideal closure line clipping that needs various directions of the aneurysm clip application. [13][14][15] For the MCAB aneurysm that projects anteroinferiorly, the course of the M1 segment usually curves superoposteriorly into the deep part of the Sylvian fissure and the frontal and temporal operculum that form the superficial part of the Sylvian fissure usually adhere tightly. [2] With the DTSA, the middle part of the M1 segment, which usually locates in the deep area of the Sylvian fissure, was not required; therefore, brain injury due to extensive Sylvian fissure dissection can be avoided.…”

Section: Advantages and Special Considerations Of The Distal Transsyl...mentioning

confidence: 99%

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

2021

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Background: Middle cerebral artery bifurcation (MCAB) aneurysms are common intracranial aneurysms. Anteroinferior-projecting MCAB aneurysms, with the M1 segment usually embedded into the deep part of the Sylvian fissure, cause some surgical challenges. The distal transsylvian approach (DTSA) allows M1 exposure from the dorsal surface for proximal control in the early step. Therefore, this study aimed to demonstrate the efficacy and safety of DTSA for clipping anteroinferior-projecting MCAB aneurysms. Materials and Methods: Among 97 patients with MCA aneurysms, 13 with anteroinferior-projecting MCAB aneurysms who underwent aneurysm clipping via the DTSA between June 2018 and January 2021 were retrospectively evaluated for the aneurysm obliteration rate, surgical complications, and outcomes. Results: Ten patients (76.9%) had ruptured MCAB aneurysms and three (23.1%) had incidentally discovered unruptured MCAB aneurysms. Favorable outcome was achieved in 100% of patients with good grade. The complete aneurysm obliteration rate was 100% without intraoperative lenticulostriate artery injury. Twelve (92.3%) patients had early identified distal M1 segment for proximal control, and one (7.7%) patient had premature rupture of aneurysm that achieved favorable outcome at 3 months postoperatively. Difficult M1 exposure and premature rupture occurred in the patient with MCAB located above the Sylvian fissure line. Permanent postoperative neurological deficit was detected in one patient due to severe vasospasm. Conclusions: DTSA, which simplify the early exposure of the dorsal surface of distal M1, is safe and effective for clipping anteroinferior-projecting MCAB aneurysms without extensive Sylvian fissure dissection. High-positioned MCAB requires careful dissection of the aneurysm neck with consideration of tentative clipping preparation.

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A novel predictor of ischemic complications in the treatment of ruptured middle cerebral artery aneurysms: Neck-branching angle

Takenaka,

Nakamura,

Yamada

et al. 2024

World Neurosurgery: X

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Middle Cerebral Artery Aneurysm “Neck Overhang”: Decreased Postclipping Residual Using the Intersecting Clipping Technique

Cited by 3 publications

References 42 publications

Early Exposure of the Dorsal Surface of M1 Segment via the Distal Transsylvian Approach for Clipping of Anteroinferior-Projecting Middle Cerebral Artery Bifurcation Aneurysms

Early Exposure of the Dorsal Surface of M1 Segment via the Distal Transsylvian Approach for Clipping of Anteroinferior-Projecting Middle Cerebral Artery Bifurcation Aneurysms

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

A novel predictor of ischemic complications in the treatment of ruptured middle cerebral artery aneurysms: Neck-branching angle

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