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Contralateral approaches to bilateral cerebral aneurysms: a microsurgical anatomical study
E M Oshiro1, D A Rini, R J Tamargo
1Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Journal of Neurosurgery
|August 1, 1997
Summary
This microsurgical study in cadavers explored contralateral surgical corridors for treating bilateral brain aneurysms. The internal carotid artery termination was fully accessible, while other anterior circulation sites had variable exposure rates.
Area of Science:
- Neurosurgery
- Anatomical Studies
- Cerebrovascular Surgery
Background:
- Bilateral supratentorial aneurysms often require multiple surgical interventions.
- A unilateral approach for clipping all aneurysms could improve surgical efficiency.
Purpose of the Study:
- To evaluate the feasibility and anatomical corridors for contralateral surgical exposure of common anterior circulation aneurysm sites.
- To determine the potential for a unilateral approach in treating bilateral aneurysms.
Main Methods:
- Microsurgical dissection in 16 human cadaver heads.
- Frontotemporal craniotomies to assess contralateral access to ophthalmic artery origin, posterior communicating artery origin, internal carotid artery termination, and middle cerebral artery bifurcation.
- Morphometric measurements of relevant neurovascular structures.
Main Results:
- 100% contralateral exposure of the internal carotid artery termination.
- 62% exposure of the ophthalmic artery origin and middle cerebral artery bifurcation.
- 50% exposure of the posterior communicating artery origin.
- Successful middle cerebral artery bifurcation exposure was dependent on M1 segment length (<14 mm).
Conclusions:
- Contralateral surgical approaches are feasible for certain anterior circulation aneurysm locations, particularly the internal carotid artery termination.
- Access to other sites like the ophthalmic artery origin and posterior communicating artery origin is variable and may require specific maneuvers.
- The feasibility of contralateral middle cerebral artery bifurcation clipping is limited by anatomical variations.