Dashti Reza, Rinne Jaakko, Hernesniemi Juha, Niemelä Mika, Kivipelto Leena, Lehecka Martin, Karatas Ayse, Avci Emel, Ishii Keisuke, Shen Hu, Peláez José G, Albayrak Baki S, Ronkainen Antti, Koivisto Timo, Jääskeläinen Juha E
Department of Neurosurgery, Helsinki University Central Hospital, 00260 Helsinki, Finland.
Surg Neurol. 2007 Jan;67(1):6-14. doi: 10.1016/j.surneu.2006.08.027.
The M1As are located in the main trunk (M1) of the MCA, between the bifurcation of the ICA and the main bifurcation of M1. Proximal MCA aneurysms are often small and thin-walled, which makes their proper clipping tedious. There are few reports on their microsurgery.
This review, and the whole series on intracranial aneurysms, is mainly based on the personal microneurosurgical experience of the senior author (JH) in 2 Finnish centers (Helsinki and Kuopio), which serve, without selection, the catchment area in the southern and eastern Finland.
These 2 centers have treated more than 10000 patients with aneurysm since 1953. We review the practical anatomy, preoperative planning, and avoidance of complications in the microsurgical dissection and clipping of M1As which form 7.4% of all intracranial and 14% of all MCA aneurysms in our patients.
Proximal MCA aneurysms are often wide-necked and intimately connected to an M1 branch at its origin on M1, features that favor exosurgery rather than endosurgery. The direction and course of the parent and branching arteries and the orientation of the fundus are the most important factors affecting the efficacy and safety of clipping.
M1段动脉瘤位于大脑中动脉（MCA）的主干（M1），在颈内动脉（ICA）分叉与M1的主要分叉之间。大脑中动脉近端动脉瘤通常较小且壁薄，这使得对其进行恰当夹闭操作繁琐。关于其显微手术的报道较少。
本综述以及整个颅内动脉瘤系列主要基于资深作者（JH）在芬兰的2个中心（赫尔辛基和库奥皮奥）的个人显微神经外科经验，这2个中心不加选择地服务于芬兰南部和东部的集水区。
自1953年以来，这2个中心已治疗了10000多名动脉瘤患者。我们回顾了M1段动脉瘤显微手术解剖、术前规划以及在显微手术分离和夹闭过程中并发症的避免，M1段动脉瘤在我们的患者中占所有颅内动脉瘤的7.4%，占所有大脑中动脉动脉瘤的14%。
大脑中动脉近端动脉瘤通常宽颈，且在M1段起源处与M1分支紧密相连，这些特征有利于采用外科学方法而非内科学方法。载瘤动脉和分支动脉的走行方向以及瘤底的朝向是影响夹闭效果和安全性的最重要因素。
