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KMID : 1005420130150030164
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Journal of Cerebrovascular and Endovascular Neurosurgery
2013 Volume.15 No. 3 p.164 ~ p.170
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Two Indices Affecting the Directions of the Sylvian Fissure Dissection in Middle Cerebral Artery Bifurcation Aneurysms
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Park Hyun-Wook
Chung Seung-Young
Park Moon-Sun
Kim Seong-Min
Yoon Byul-Hee
Kim Han-Kyu
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Abstract
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Objective: This study proposes more objective methods for deciding the appropriate direction of the sylvian fissure dissection during surgical clipping in middle cerebral artery (MCA) bifurcation aneurysms.
Methods: We reviewed data of 36 consecutive patients with MCA bifurcation aneurysms. We measured 2 indices preoperatively on 3-dimensional computed tomography angiography (3D-CTA). Analysis of the calculated data allowed us to select the appropriate direction of sylvian fissure dissection for ease of proximal control of M1. Statistically, Mann-Whitney test was used.
Results: We classified subjects into 2 groups based on the technical level of M1 exposure during surgical clipping. When it was difficult to expose M1, subjects were assigned to Group I, and Group II were subjects in whom M1 exposure was easy. The mean difference between the distances extending from the limbus sphenoidale (LS) line to the internal carotid artery bifurcation and extending from the LS line to the MCA bifurcation was 1.00 ± 0.42 mm in group I and 4.39 ± 2.14 mm in group II. The mean M1 angle was 9.36 ± 3.73° in the group I and 34.05 ± 16.71° in the group II (M1 slope gap p < 0.05, M1 angle p < 0.05).
CoConclusion: We have found an objective method for preoperatively verifying ease of exposure of M1 artery during surgical clipping. Therefore, we suggest use of the preoperative M1 slope gap and M1 angle as indicators in 3D-CTA selecting the direction of sylvian fissure dissection for easy proximal control of M1.
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KEYWORD
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Middle cerebral artery, Intracranial aneurysm, Dissecting, Three-dimensional cerebral angiography
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