The Minipterional Craniotomy for Anterior Circulation Aneurysms

Abstract

The MPT craniotomy is a worthwhile alternative to the standard pterional craniotomy. There were no instances of suboptimal operative corridors and clip applications when the MPT craniotomy was utilized in the treatment of unruptured middle cerebral artery and supraclinoid internal carotid artery aneurysms proximal to the terminal internal carotid artery bifurcation.

Minimally Invasive Microsurgery for Cerebral Aneurysms

“…The MPTC provides access to the inferior frontal and superior temporal gyri, the Sylvian fissure dissection to the anterior ascendant ramus, and the aneurysms of the carotid and middle cerebral arteries. 4,20 Limitations include restricted access to the distal Sylvian fissure, especially in the case of brain swelling or hemorrhage.…”

“…23 Overall, MPTC is most suited for aneurysms requiring a full Sylvian fissure split, for example, MCA, ICA bifurcation, and ophthalmic artery aneurysms. 18,20 LSOC provides a narrower access to the Sylvian fissure and may be most suited to aneurysms of terminal ICA (posterior communicating artery [PComA], anterior choroidal artery), simple ACA, and AComA. Aneurysms of ACA and AComA may be more amenable to SOC.…”

“…8,24 Caplan et al reported their experience of 82 unruptured aneurysms treated with the MPTC over 4.5 years, which included MCA (44%), PComA (27%), and paraophthalmic artery (27%). 20 Of these, 84.2% of aneurysms were clipped, 13.4% were wrapped with cotton and fibrin glue, and average length of stay was 4.0 days. Welling et al performed a randomized trial evaluating the clinical, functional, and esthetic results between MPTC and PTC for ruptured and unruptured aneurysms.…”

Treatment of middle cerebral artery (MCA) aneurysms: a review of the literature

“…Most MCA aneurysms can be directly viewed after a pterional or minipterional craniotomy combined with arachnoid dissection through the Sylvian fissure corridor with minimal brain retraction [16,45]. The surgical field can be widely opened with minimal manipulation of surrounding brain tissue to provide sufficient exposure of the aneurysm and the related MCA vessels, with ability to maneuver for clip application.…”

Treatment of Intracranial Aneurysms: Clipping Versus Coiling

“…Because of the spring mechanism of the clip, once placed, it is able to exclude the IA from the parent blood vessel and obstruct further blood flow entry into the IA. Recent improvements in outcomes of microsurgical clipping include the use of intraoperative angiography [53], electrophysiological monitoring, tailored craniotomies [54], and indocyanine green videoangiography [55].…”