• Reza Dashti, Juha Hernesniemi, Mika Niemelä, Jaakko Rinne, Matti Porras, Martin Lehecka, Hu Shen, Baki S Albayrak, Hanna Lehto, Päivi Koroknay-Pál, Rafael Sillero de Oliveira, Giancarlo Perra, Antti Ronkainen, Timo Koivisto, and Juha E Jääskeläinen.
• Department of Neurosurgery, Helsinki University Central Hospital, 00260 Helsinki, Finland.
• Surg Neurol. 2007 May 1;67(5):441-56.

BackgroundOf the MCA aneurysms, those located at the main bifurcation of the MCA (MbifA) are by far the most frequent. The purpose of this article is to review the practical anatomy, preoperative planning, and avoidance of complications in the microsurgical dissection and clipping of MbifAs.MethodsThis review, and the whole series on intracranial aneurysms, is mainly based on the personal microneurosurgical experience of the senior author (JH) in 2 Finnish centers (Helsinki and Kuopio), which serve without patient selection the catchment area in southern and eastern Finland.ResultsThese 2 centers have treated more than 10,000 patients with intracranial aneurysm's since 1951. In the Kuopio Cerebral Aneurysm Data Base of 3005 patients with 4253 aneurysms, MbifAs formed 30% of all ruptured aneurysms, 36% of all unruptured aneurysms, 35% of all giant aneurysms, and 89% of all MCA aneurysms. Importantly, in 45%, rupture of MbifA caused an ICH.ConclusionsMiddle cerebral artery bifurcation aneurysms are often broad necked and may involve one or both branches of the bifurcation (M2s). The anatomical and hemodynamic features of MbifAs make them usually more favorable for microneurosurgical treatment. In population-based services, MbifAs are frequent targets of elective surgery (unruptured), acute surgery (ruptured), and emergency surgery (large ICH), even advanced approaches (giant). The challenge is to clip the neck adequately, without neck remnants, while preserving the bifurcational flow.

29 keywords...

hide…