• Atos Alves de Sousa, Marcos Antônio Dellaretti Filho, Wilson Faglioni, and Gervásio Teles Cardoso Carvalho.
• Faculdade de Ciências Médicas de Minas Gerais, Santa Casa de Belo Horizonte, Belo Horizonte, MG 30150-310, Brazil. sousatos@terra.com.br
• Surg Neurol. 2005 Jan 1; 63 Suppl 1: S1-7.

BackgroundThe aim of the present study was to evaluate the technical viability of the unilateral pterional approach to simultaneously treat symmetrical bilateral aneurysm (mirror image) of the middle cerebral arteries (SBAMCA) and to determine the morbidity and mortality rates of this approach.MethodsForty-six patients with SBAMCA underwent unilateral pterional craniotomy within a period of 9 years. Most patients were women (24, 80.0%) and mean age was 40.7 years.ResultsObliteration of the contralateral aneurysm was not possible in 16 patients (34.8%) because of brain edema in 8 patients operated on during the acute phase, lateral projection of the aneurysm in 3, a very long contralateral M1 segment in 4, and the presence of atheromatous plaques at the MCA bifurcation and aneurysm neck in 1. The remaining 30 patients (65.2%) were submitted to the proposed treatment. Final evaluation showed that 26 patients (86.7%) were Glasgow Outcome Scale (GOS) V, 1 patient (3.3%) was GOS IV, 2 patients (6.6%) were GOS III, and 1 patient (3.3%) was GOS I.ConclusionsThe unilateral pterional surgical approach to treat SBAMCA is a technically viable procedure associated with low morbidity and mortality. However, it requires a neurosurgeon experienced in cerebral aneurysm surgery and the appropriate technical conditions.

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