[Microsurgical exposure of middle cerebral aneurysms located at the limen recess].
OBJECTIVE
To describe techniques of exposure for middle cerebral artery (MCA) aneurysms located at the limen recess.


METHODS
A retrospective review was performed of 17 patients who underwent clipping surgery, during a 3-year period, to MCA aneurysms located at the limen recess. All clinical and imaging data were reviewed.


RESULTS
Techniques required in the limen recess MCA aneurysms were: 1) Wide exposure of the sylvian fissure (from the distal part to the carotid cistern), 2) Secure the M1 proximal, 3) Temporary occlusion, 4) Perpendicular clip. Temporary occlusion was employed in 13 of 17 patients. No procedure related morbidity was observed.


CONCLUSIONS
Difficulty lies in the circumstance that the aneurysm frequently has its orifice 270 degree, while the clip has to be applied perpendicular to the M2 axis in a narrow working space. Using temporary clip and extensive exposure may be the key to avoid brain damage in the surgery of MCA aneurysms located at the limen recess.
Department of Neurosurgery, Teine Keijinkai Hospital, 1-40 1-jo 12-chome, Maeda, Teine-ku, Sapporo-shi, Hokkaido 006-8555, Japan.
Ken
K
Kazumata
Katsuyuki
K
Asaoka
Kouji
K
Itamoto
Yuka
Y
Yokoyama
Satoshi
S
Ushikoshi
Osamu
O
Kikuchi
D000328:Adult; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*