Contralateral Approach to Middle Cerebral Artery Aneurysms: An Anatomical-Clinical Analysis to Improve Patient Selection.

Contralateral Approach to Middle Cerebral Artery Aneurysms: An Anatomical-Clinical Analysis to Improve Patient Selection.

World Neurosurg. 2017 Oct 04;:

Authors: Tayebi Meybodi A, Lawton MT, Rodriguez Rubio R, Yousef S, Benet A

Abstract
BACKGROUND: A contralateral approach to clip a middle cerebral artery (MCA) aneurysm in case of bilateral intracranial 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 at 5-mm increments. Also, 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 in the angiograms.
RESULTS: The average length of the MCA from its origin to the aneurysm neck in patients treated via contralateral approach was 12.4mm. Starting at the MCA origin, surgical freedom decreased significantly between all adjacent target points, except between 5 - 10mm from the MCA origin.
CONCLUSION: After the proximal 5mm, there is no significant decrease of surgical maneuverability within the proximal 10mm 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 10mm (average 12.4mm) of the contralateral MCA may be regarded as a surgical comfort zone for a contralateral approach. This criterion may be useful for patient selection for a contralateral approach in case of multiple bilateral intracranial aneurysms.

PMID: 28987838 [PubMed - as supplied by publisher]

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