[Microsurgical treatment of a series of intracranial subtentorial arterial aneurysms].

A series of 60 arterial aneurysms is reported, pateints pre-operatively being from grade I to grade IV of the classification of Botterell. Microsurgical technique is emphasized : patients are operated on through the fronto-lateral approach described by Yasargil. The most patients with anterior communicating artery aneurysm are operated on from the right side, except for patients with only one left anterior cerebral artery. Middle cerebral artery aneurysms are approached by the proximal way, along the internal carotid artery and then following the main trunk of middle cerebral artery. Concerning the internal carotid artery aneurysms, the carotid bifurcation aneurysms, the true posterior communicating artery aneurysms, dissection is generally performed without particular difficulty, except for the low internal carotid artery aneurysms (carotido-ophtalmic aneurysms); in these latter, the anterior clinoid process and the internal part of sphenoidal ridge must be removed. In case of intra-cerebral hematoma, only a part of hematoma is at first sucked away, up to a sufficient view of the chiasmatic cistern; then, releasing of cerebro-spinal fluid allows the management of the aneurysm and the remaining part of hematoma is totally evacuated after clipping of aneurysm. Reduction of the neck and sometimes of the whole aneurysm is performed with bipolar forceps. Every aneurysm was treated with metal clip (Yasargil, Scoville, Heifetz, Sundt's clip-graft). In no case a silk ligature was used...