| Contralateral Clipping of Middle Cerebral Artery Aneurysms: Rationale, Indications, and Surgical Technique. | |
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MedLine Citation:
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PMID: 22307073 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Contralateral clipping of MCA aneurysms seems dangerous and ill advised, but could become an important technique because of the prevalence of MCA aneurysms, the limitations of endovascular therapy, and increasing interest in less invasive techniques. OBJECTIVE: To define patient selection, surgical technique, and results with contralateral MCA aneurysm clipping. METHODS: 42 patients with bilateral MCA aneurysms were treated either in one stage with a single craniotomy and contralateral aneurysm clipping (Group 1, 11 patients) or in two stages with bilateral craniotomy (Group 2, 31 patients). Surgical technique consisted of ipsilateral Sylvian fissure split, subfrontal dissection, contralateral Sylvian fissure split, mobilization of medial orbital gyrus, and contralateral aneurysm clipping. RESULTS: Group 1 patients were older than group 2 patients, (60.3 versus 55.4 years, respectively). Clinical presentation with subarachnoid hemorrhage was less common in Group 1. Nine Group 1 patients (82%) had left-sided craniotomies, and the ipsilateral aneurysm was larger than the contralateral aneurysm. All aneurysms were clipped without intraoperative complications (136 aneurysms). Mean neurosurgical charges were decreased by contralateral MCA aneurysm clipping: $39,297 in Group 1 versus $57,977 in Group 2. CONCLUSION: Contralateral MCA aneurysm clipping can be viewed as an extreme microsurgical technique, or as a less invasive technique that spares patients a second craniotomy in the management of bilateral aneurysms. This technique is acceptable in selected patients with contralateral aneurysms that are unruptured, have simple necks, project inferiorly or anteriorly, are associated with short M1 segments, and reside in older patients with Sylvian fissures widened by brain atrophy. |
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Authors:
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Ana Rodríguez-Hernández; Andreu Gabarrós; Michael T Lawton |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-2-2 |
Journal Detail:
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Title: Neurosurgery Volume: - ISSN: 1524-4040 ISO Abbreviation: - Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-2-6 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1Department of Neurological Surgery, University of California, San Francisco 2Department of Neurological Surgery, Hospital de Bellvitge, Barcelona. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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