title: Single-stage operation for bilateral middle cerebral artery aneurysms.
abstract: BACKGROUND
  Subarachnoid haemorrhage with bilateral middle cerebral artery aneurysms is occasionally encountered in neurosurgical practice. We report upon our experiences of the single-stage operation for bilateral middle cerebral artery aneurysms (BMCA) through a bilateral subfrontal approach.
  
  
  METHODS
  During the past two and half years, we have experienced three cases of BMCAA, who were treated by this method. The whole procedure was conducted using a single-stage head positioning and draping. Slight table tilting was enough to allow the proper clipping of each aneurysm.
  
  
  RESULTS
  During the past 2.5 years, 255 cases of intracranial aneurysm have been treated in our hospital. Among these, the incidence of BMCAA was 1.18% (3/255). The mean duration of operation for the three cases involved was 5.8 hours, and showed a progressive decrease with experience. All patients recovered well, and were discharged as in other uneventful aneurysm cases. The total operation time was longer, and was a little more laborious than normal single aneurysm surgery.
  
  
  CONCLUSIONS
  This method has substantial advantages over "classical" skull base approaches to MCA aneurysms. As extensive frontal lobe manipulation and external facial incisions are avoided with subfrontal approaches, intensive care unit and overall hospital stay are reduced, related complications are minimized, and postoperative cosmetic appearance is enhanced.
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: B G
authors.initials: BG
authors.lastname: Shin
authors.forename: J S
authors.initials: JS
authors.lastname: Kim
authors.forename: S C
authors.initials: SC
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005625:Frontal Lobe / Q000601:surgery; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D011859:Radiography; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome