Dashti Reza, Hernesniemi Juha, Niemelä Mika, Rinne Jaakko, Porras Matti, Lehecka Martin, Shen Hu, Albayrak Baki S, Lehto Hanna, Koroknay-Pál Päivi, de Oliveira Rafael Sillero, Perra Giancarlo, Ronkainen Antti, Koivisto Timo, Jääskeläinen Juha E
Department of Neurosurgery, Helsinki University Central Hospital, 00260 Helsinki, Finland.
Surg Neurol. 2007 May;67(5):441-56. doi: 10.1016/j.surneu.2006.11.056.
Of the MCA aneurysms, those located at the main bifurcation of the MCA (MbifA) are by far the most frequent. The purpose of this article is to review the practical anatomy, preoperative planning, and avoidance of complications in the microsurgical dissection and clipping of MbifAs.
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 patient selection the catchment area in southern and eastern Finland.
These 2 centers have treated more than 10,000 patients with intracranial aneurysm's since 1951. In the Kuopio Cerebral Aneurysm Data Base of 3005 patients with 4253 aneurysms, MbifAs formed 30% of all ruptured aneurysms, 36% of all unruptured aneurysms, 35% of all giant aneurysms, and 89% of all MCA aneurysms. Importantly, in 45%, rupture of MbifA caused an ICH.
Middle cerebral artery bifurcation aneurysms are often broad necked and may involve one or both branches of the bifurcation (M2s). The anatomical and hemodynamic features of MbifAs make them usually more favorable for microneurosurgical treatment. In population-based services, MbifAs are frequent targets of elective surgery (unruptured), acute surgery (ruptured), and emergency surgery (large ICH), even advanced approaches (giant). The challenge is to clip the neck adequately, without neck remnants, while preserving the bifurcational flow.
在大脑中动脉（MCA）动脉瘤中，位于MCA主分叉处（MbifA）的动脉瘤最为常见。本文旨在回顾MbifA显微手术解剖、术前规划以及在显微手术夹闭过程中并发症的避免。
本综述以及关于颅内动脉瘤的整个系列主要基于资深作者（JH）在芬兰的两个中心（赫尔辛基和库奥皮奥）的个人显微神经外科经验，这两个中心为芬兰南部和东部的整个服务区域提供服务，且不进行患者选择。
自1951年以来，这两个中心已治疗了10000多名颅内动脉瘤患者。在库奥皮奥脑动脉瘤数据库中，3005例患者共4253个动脉瘤，MbifA占所有破裂动脉瘤的30%，所有未破裂动脉瘤的36%，所有巨大动脉瘤的35%，以及所有MCA动脉瘤的89%。重要的是，45%的MbifA破裂会导致颅内出血（ICH）。
大脑中动脉分叉处动脉瘤通常颈宽，可能累及分叉的一个或两个分支（M2）。MbifA的解剖和血流动力学特征使其通常更适合显微神经外科治疗。在基于人群的服务中，MbifA是择期手术（未破裂）、急诊手术（破裂）和紧急手术（大量ICH）甚至高级手术方法（巨大动脉瘤）的常见目标。挑战在于在保留分叉血流的同时充分夹闭瘤颈，不留瘤颈残余。
