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Contralateral Approach to Middle Cerebral Artery Aneurysms: An Anatomical-Clinical Analysis to Improve Patient Selection.
Meybodi, Ali Tayebi; Lawton, Michael T; Rubio, Roberto Rodriguez; Yousef, Sonia; Benet, Arnau.
Afiliación
  • Meybodi AT; Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
  • Lawton MT; Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
  • Rubio RR; Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
  • Yousef S; Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
  • Benet A; Department of Neurological Surgery, University of California, San Francisco, California, USA; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA. Electronic address: arnaubenet@gmail.com.
World Neurosurg ; 109: e274-e280, 2018 Jan.
Article en En | MEDLINE | ID: mdl-28987838
BACKGROUND: A contralateral approach to aneurysm clipping in cases of bilateral middle cerebral artery (MCA) aneurysms reduces surgical time and cost. However, there is a lack of evidence for objective patient selection. In this study, we assessed the change in surgical freedom along the contralateral MCA to provide objective evidence for patient selection. METHODS: Sixteen cadaveric specimens were studied. Through a pterional approach, the surgical freedom was calculated moving distally along the contralateral MCA in 5-mm increments. In addition, in a series of 19 MCA aneurysms clipped contralaterally by the senior author, the average length of the MCA from its origin to the aneurysm neck was measured on angiography. RESULTS: In these patients treated via a contralateral approach, the average length of the MCA segment from its origin to the aneurysm neck was 12.4 mm. Starting at the MCA origin, surgical freedom decreased significantly between all adjacent target points except at 5-10 mm from the MCA origin. CONCLUSIONS: After the proximal 5 mm, there is no significant decrease in surgical maneuverability within the proximal 10 mm of MCA when approached contralaterally. When compared to the average length of the MCA from its origin to the aneurysm neck in the clinical series, it can be concluded that the first 10 mm (average, 12.4 mm) of the contralateral MCA may be considered a surgical comfort zone for a contralateral approach. This criterion may be useful for patient selection for a contralateral approach in cases of multiple bilateral intracranial aneurysms.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aneurisma Intracraneal / Selección de Paciente / Dominancia Cerebral Límite: Aged / Female / Humans Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2018 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aneurisma Intracraneal / Selección de Paciente / Dominancia Cerebral Límite: Aged / Female / Humans Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2018 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos