Middle cerebral artery aneurysm surgery approaches [Neurosurgery Wiki]

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====== Middle cerebral artery aneurysm surgery approaches ======

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The main access route for middle cerebral artery (MCA) aneurysms is the [[transsylvian approach]]. 

see [[Transsylvian approach to middle cerebral artery aneurysm]].

see [[Superior Temporal Gyrus Approach to Middle Cerebral Artery Aneurysm]].

===== Pterional craniotomy =====
see [[Pterional craniotomy]].


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In most cases of [[Middle cerebral artery aneurysm surgery]] the decision as to which surgical approach to use is made preoperatively depending on the presence of intraparenchymal clot, size of aneurysm, direction of aneurysm, and length of the proximal middle cerebral artery

Ogilvy et al., used the [[superior temporal gyrus]] when intraparenchymal hematoma was present in the [[temporal lobe]] or when the length of the [[middle cerebral artery trunk]] was long (average length 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.
((Ogilvy CS, Crowell RM, Heros RC. Surgical management of middle cerebral artery
aneurysms: experience with transsylvian and superior temporal gyrus approaches.
Surg Neurol. 1995 Jan;43(1):15-22; discussion 22-4. PubMed PMID: 7701417.
)).

===== Transsylvian Approach to Middle Cerebral Artery Aneurysm =====

see [[Transsylvian Approach to Middle Cerebral Artery Aneurysm]].



===== Through small temporal craniotomy and linear skin incision =====
There were no complications of temporal muscle atrophy, scar deformity, paresthesia, or pain around the scalp incision and frontalis palsy. This approach offers good surgical possibilities and little approach related morbidity in the clipping of incidental MCA aneurysms
((Mun JH, Cho KY, Lee RS, Lim BC, Choi TM, Lim JS. Clipping of incidental
aneurysm of middle cerebral artery through small temporal craniotomy and linear
skin incision. J Cerebrovasc Endovasc Neurosurg. 2014 Mar;16(1):32-8. doi:
10.7461/jcen.2014.16.1.32. Epub 2014 Mar 31. PubMed PMID: 24765611.)).

===== Sylvian fissure dissection =====

[[Sylvian fissure dissection]].


===== References =====