Discussion On The Surgical Techniques For The Clippingof Middle Cerebral Artery Aneurysm

Objective: It is common treatment method that surgical clip the MCAA in clinical application.The paper analyzed operation characteristics,the postoperative complications,postoperative recovery of patients who were treated by pterional approach, pterional keyhole approach and eyebrowl keyhole approach in surgical clipping MCAA.We discuss the indications and surgical skills of the three surgical approach,then providing reference for clinical application.Methods:The surgical data of 39 MCAA patients were analyzed retrospectively form 2012 to 2015. The subjects were categorized into three groups:pterional approach group(25 cases), pterional keyhole approach group(10 cases),eyebrow keyhole approach group(4 cases). Pterional approach group:the first rupture bleeding(25 cases,including 2 cases with intracranial hematoma);Hunt-Hess grade I to III(20 cases), Hunt-Hess grade IV(2 cases), Hunt-Hess grade V(3 cases);single MCAA(21 cases), bilateral MCAA(3 cases),combining posterior communicating artery aneurysm(1 case);in MAC M1 segment(24 cases),in MAC M2 segment(1 case).Pterional keyhole approach group:the first rupture bleeding(9 cases),non rupture bleeding(1 case);Hunt-Hess grade I(1 case),Hunt-Hess grade II(5 cases),Hunt-Hess grade III(3 cases);in MAC M1 segment(10 cases).Eyebrow keyhole approach group:the first rupture bleeding(4 cases);Hunt-Hess grade I(1 case),Hunt-Hess grade II(1 case),Hunt-Hess grade III(2 cases);single MCAA(1 case), bilateral MCAA(2 cases),combining anterior communicating artery aneurysm(1 case);in MAC M1 segment(4 cases).According to the Hunt-Hess grade,position,size,orientation,the relationship with parental artery of the aneurysm,operators’ experience and surgical skills,dissecting aneurysm and clipping the aneurysm after the parental arteries are exposed fully by the pterional approach, pterional keyhole approach and eyebrow keyhole approach.Rseults:We successfully clipped 41 aneurysms in 39 patients in three groups.All patients were followed up for 0.5-2 years.Pterional approach group:intracranial infection(3 cases),cerebral infarction(4 cases),subdural effusion(1 case),hydrocephalus(2 cases,treated with lateral ventricleperitoneal shunt);recovered to normal in Hunt-Hess grade I to III(20 cases),mild disability in Hunt-Hess grade IV(1 case),moderate disability in Hunt-Hess grade IV(1 case),moderate disability in Hunt-Hess grade V(1 case),death in Hunt-Hess grade V(2 cases).Pterional keyhole approach group:intracranial infection(1 case),on the right side of basal ganglia region cerebral infarction(1 case).Eyebrow keyhole approach group:on the right side of basal ganglia region cerebral infarction(1 case).All 14 patients recovered to normal in pterional keyhole approach group and eyebrow keyhole approach group.Conclusion:The pterional approach, pterional keyhole approach and eyebrow keyhole approach can carried out successfully for the most patients with MCAA.According to the patient’s Hunt-Hess grade, position,size,orientation,the relationship with parental artery of the aneurysm,operators’ experience and surgical skills, the doctor should select the best surgical approach in a personal choosing model.