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Orbitozygomatic Craniotomy for Clipping a Complex Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video.

Benjamin K Hendricks1, Robert F Spetzler1

  • 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.

Operative Neurosurgery (Hagerstown, Md.)
|November 24, 2019
PubMed
Summary

This study details the successful surgical clipping of a wide-necked middle cerebral artery (MCA) aneurysm. The procedure ensured complete aneurysm obliteration while preserving the parent artery, offering a viable treatment option for complex MCA aneurysms.

Keywords:
AneurysmLeft orbitozygomatic craniotomyMiddle cerebral artery

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Area of Science:

  • Neurosurgery
  • Vascular Neurology
  • Cerebrovascular Surgery

Background:

  • Middle cerebral artery (MCA) aneurysms present significant surgical challenges due to large parent artery caliber and the need for extensive sylvian fissure dissection.
  • Adequate dissection of the aneurysm neck is crucial for visualizing and protecting adjacent lenticulostriate perforators.

Purpose of the Study:

  • To describe the surgical management of a complex left-sided, wide-necked, bilobed MCA aneurysm at the M1 bifurcation.
  • To demonstrate the efficacy of a specific surgical approach for achieving aneurysm obliteration and parent vessel patency.

Main Methods:

  • The aneurysm was accessed via a left orbitozygomatic craniotomy.
  • Distal sylvian fissure dissection was performed to gain proximal and distal control.
  • A single curved surgical clip was used for aneurysm occlusion.

Main Results:

  • Postoperative angiography confirmed complete obliteration of the MCA aneurysm.
  • The parent artery remained patent after the clipping procedure.
  • The surgical technique was effective in managing this challenging aneurysm anatomy.

Conclusions:

  • Surgical clipping, utilizing an orbitozygomatic approach and distal sylvian fissure dissection, is an effective method for treating wide-necked MCA aneurysms.
  • This technique allows for safe and complete occlusion of complex MCA aneurysms while preserving critical perforating arteries.
  • The described approach offers a valuable option for neurosurgeons managing challenging MCA aneurysm cases.