title: Contralateral Approach to Bilateral Middle Cerebral Artery Aneurysms: Comparative Study, Angiographic Analysis, and Surgical Results.
abstract: BACKGROUND
  Bilateral aneurysms located between the 2 middle cerebral artery (MCA) bifurcations may be approachable through a single unilateral approach.
  
  
  OBJECTIVE
  To identify anatomic parameters based on imaging that would favor a contralateral approach.
  
  
  METHODS
  From January 1998 to December 2013, we retrospectively identified 173 patients with bilateral intracranial aneurysms. Fifty-one patients had bilateral MCA aneurysms. A total of 38 patients underwent a single craniotomy with a contralateral microsurgical approach (group 1 or contralateral group) and 13 patients underwent bilateral craniotomies (group 2 or bilateral group). For both groups, we analyzed aneurysm characteristics, morphology, size, projections, and distance to the contralateral corridor, as well as surgical time, outcome, and postoperative complications.
  
  
  RESULTS
  All aneurysms approached contralaterally were unruptured and without wall calcifications. Of the contralaterally approached aneurysms, 97% were smaller than 14 mm. The median length of the contralateral A1 was 13.2 mm (range: 6-19.8 mm) and the median length of the contralateral M1 was 14.2 mm (range: 4.6-21 mm). The contralateral group had a good postoperative outcome (modified Rankin Scale 0-3) in 80% of ruptured cases and 86% of unruptured cases. The median surgical time was 120 minutes (range: 75-255 minutes), 43% shorter than the bilateral group.
  
  
  CONCLUSIONS
  The contralateral approach for bilateral MCA aneurysms in selected patients is feasible in experienced hands, with acceptable morbidity and mortality. The contralateral approach requires a meticulous preoperative analysis of the characteristics of the aneurysms to be clipped and of the anatomic constraints of the microsurgical operative corridor.
  
  
  BACKGROUND
  A1, anterior cerebral artery proximal segmentbMCA, bilateral middle cerebral arteryCTA, computed tomographic angiographyHH, Hunt-Hess scaleIA, intracranial aneurysmsICA, internal carotid arteryICAbif, internal carotid artery bifurcationMCA, middle cerebral arteryM1, middle cerebral artery proximal segmentmRS, modified Rankin ScaleSAH, subarachnoid hemorrhage.
authors: *Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; ‡Department of Neurosurgery, University Central Hospital Antonio Maria Pineda, Barquisimeto, Venezuela; §Department of Neurosurgery, Stroke Center, Bergmannstrost Hospital, Halle, Germany; ¶Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan; ‖Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois; #Department of Neurosurgery, Kuopio University Central Hospital, Kuopio, Finland.
authors: Hugo
authors: H
authors: Andrade-Barazarte
authors: Juri
authors: J
authors: Kivelev
authors: Felix
authors: F
authors: Goehre
authors: Behnam Rezai
authors: BR
authors: Jahromi
authors: Kosumo
authors: K
authors: Noda
authors: Tarik F
authors: TF
authors: Ibrahim
authors: Riku
authors: R
authors: Kivisaari
authors: Hanna
authors: H
authors: Lehto
authors: Mika
authors: M
authors: Niemela
authors: Juha E
authors: JE
authors: Jääskeläinen
authors: Juha A
authors: JA
authors: Hernesniemi
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D003399:Craniotomy; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D020768:Middle Cerebral Artery; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome