The transsylvian approach to middle cerebral artery bifurcation/trifurcation aneurysms

A transsylvian approach to treat aneurysms located at the bifurcation/trifurcation of the middle cerebral artery (MCA) is described. This surgical route traces a distal MCA branch retrogradely into the Sylvian fissure whereupon a secondary MCA branch and the main stem of the MCA (M1) are identified before aneurysm clipping. The advantages, and disadvantages of this approach are discussed. The transsylvian route should be considered as an alternative to the traditional pterional approach, which utilizes proximal to distal dissection of the MCA, in situations when the M1 is long or when the pterional approach is inadvisable.