SURGICAL-MANAGEMENT OF MIDDLE CEREBRAL-ARTERY ANEURYSMS - EXPERIENCE WITH TRANSSYLVIAN AND SUPERIOR TEMPORAL GYRUS APPROACHES

BACKGROUND Middle cerebral artery (MCA) aneurysms are typically approa ched surgically using one of three basic techniques. The sylvian fissu re can be opened in one of two ways; either from medial to lateral or from lateral to medial, Alternatively, an incision in the superior tem poral gyrus with subpial resection can be used to expose the MCA branc hes and aneurysm neck. METHODS We reviewed 65 middle cerebral aneurysm s in 62 patients operated on over a 5-year interval where a choice of operative approach was made based on preoperative evaluation of availa ble radiological studies, RESULTS The superior temporal gyrus was used when intraparenchymal hematoma was present in the temporal lobe or wh en the length of the middle cerebral artery trunk was long (average le ngth 2.44 +/- 0.41 SE cm), This approach was used in 20 operations on 22 aneurysms. The sylvian fissure approach was used in cases where the middle cerebral artery main trunk was short (1.32 +/- 0.41 SE cm) or the direction of the aneurysm was favorable. This approach was used in 38 operations. In 4 operations (5 aneurysms) we combined the two appr oaches to remove dot, obtain adequate exposure, and secure control of the proximal MCA, CONCLUSIONS In most cases of MCA aneurysms the decis ion as to which surgical approach to use is made preoperatively depend ing on the presence of intraparenchymal clot, size of aneurysm, direct ion of aneurysm, and length of the proximal middle cerebral artery.