Clipping of MCA aneurysms: how I do it

Area of Science:

• Neurosurgery
• Vascular Neurology

Background:

• Middle cerebral artery (MCA) bifurcation aneurysms are a common neurosurgical indication.
• Safe surgical access to Sylvian fissure aneurysms requires specific techniques.

Purpose of the Study:

• To detail the steps for safe surgical management of Sylvian fissure aneurysms.
• To emphasize the importance of minimally invasive techniques and intraoperative guidance.

Main Methods:

• Preoperative and intraoperative 3D-reconstructed angiography for surgical planning and immediate assessment.
• Minimally invasive Sylvian fissure exposure using cottonoids to maintain cistern patency and avoid brain retraction.
• Continuous monitoring of motor evoked potentials (MEPs) and intraoperative indocyanine green (ICG) microscopic angio-fluorescence for vascular integrity.

Main Results:

• The described technique facilitates safe surgical access and aneurysm treatment.
• Continuous neuro-monitoring and ICG angio-fluorescence effectively detect vascular compromise.
• Intraoperative angiography allows for prompt correction of any suboptimal surgical results.

Conclusions:

• Careful surgical planning and a minimally invasive approach are crucial for safe aneurysm surgery.
• Continuous neuro-monitoring and intraoperative radiological guidance are essential for optimal patient management and outcomes.