Microsurgical management of the middle cerebral artery bifurcation aneurysms: An anatomic feasibility study

Ali Karadag, Baran Bozkurt, Kaan Yagmurlu, Ada Irmak Ozcan, Sean L Moen, Andrew W. Grande

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: The proper head positioning decreases the surgical complications by enabling a better surgical maneuverability. Middle cerebral artery (MCA) bifurcation aneurysms have been classified by Dashti et al. [Surg Neurol. 2007 May;67(5):441-56] as the intertruncal, inferior, lateral, insular, and complex types based on dome projection. Our aim was to identify the optimum head positions and to explain the anatomic variables, which may affect the surgical strategy of MCA bifurcation aneurysms. Methods: The lateral supraorbital approach bilaterally was performed in the 4 cadaveric heads. All steps of the dissection were recorded using digital camera. Results: The distal Sylvian fissure (SF) dissection may be preferred for insular type and the proximal SF dissection may be preferred for all other types. Fifteen degrees head rotation was found as the most suitable position for the intertruncal, lateral type and subtype of complex aneurysms related with superior trunk. Thirty degrees head rotation was found the most suitable position for the inferior type, insular type, and subtype of complex aneurysms related with inferior trunk. Conclusions: The head positioning in middle cerebral bifurcation aneurysms surgery is a critical step. It should be tailored according to the projection and its relationship with the parent vessels of the middle cerebral bifurcation.

Original languageEnglish (US)
Pages (from-to)187-195
Number of pages9
JournalORL
Volume83
Issue number3
Early online dateMar 15 2021
DOIs
StatePublished - Mar 16 2021

Bibliographical note

Publisher Copyright:
© 2021 S. Karger AG, Basel. Copyright: All rights reserved.

Keywords

  • Anatomy
  • Aneurysm
  • Bifurcation
  • Middle cerebral artery
  • Projection

PubMed: MeSH publication types

  • Journal Article

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