title: Clipping of MCA aneurysms: how I do it.
abstract: BACKGROUND
  Aneurysms located at the middle cerebral artery bifurcation remain a clear neurosurgical indication. We detail here the steps necessary to enable safe surgery for Sylvian fissure aneurysms.
  
  
  METHODS
  An angiogram with 3D reconstruction is obtained and reviewed intraoperatively, just prior to the skin incision. During the exposure, the cistern is kept open by small cottonoids, thereby avoiding brain retraction. Continuous monitoring of MEPs along with ICG microscopic angio-fluorescence allows for detection of vascular compromise. Intraoperative angiography with 3D reconstruction allows for immediate correction of less than satisfactory surgical outcome.
  
  
  CONCLUSIONS
  Careful planning of surgical strategy followed by a minimally invasive technique (with continuous neuro-monitoring) ensures safe surgery. The availability of intra-operative radiological guidance allows for optimal management.
authors.affiliation: Service de Neurochirurgie, Département de Neurosciences Cliniques, Hôpitaux Universitaire de Genève, Faculté de médecine, Université de Genève, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland. philippe.bijlenga@hcuge.ch
authors.forename: Philippe
authors.initials: P
authors.lastname: Bijlenga
authors.forename: Vitor
authors.initials: V
authors.lastname: Mendes Pereira
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
mesh_terms: D002533:Cerebral Angiography / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016343:Monitoring, Intraoperative / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D013525:Surgical Instruments / Q000592:standards*; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*