Department of Neurological Surgery, University of California, San Francisco, California 94143-0112, USA.
Neurosurgery. 2012 Sep;71(1 Suppl Operative):116-23; discussion 123-4. doi: 10.1227/NEU.0b013e31824d8f66.
Contralateral clipping of middle cerebral artery (MCA) aneurysms seems dangerous and ill advised but could become an important technique because of the prevalence of MCA aneurysms, the limitations of endovascular therapy, and increasing interest in less invasive techniques.
To define patient selection, surgical technique, and results with contralateral MCA aneurysm clipping.
Forty-two patients with bilateral MCA aneurysms were treated either in 1 stage with a single craniotomy and contralateral aneurysm clipping (group 1, 11 patients) or in 2 stages with bilateral craniotomy (group 2, 31 patients). Surgical technique consisted of ipsilateral sylvian fissure split, subfrontal dissection, contralateral sylvian fissure split, mobilization of medial orbital gyrus, and contralateral aneurysm clipping.
Group 1 patients were older than group 2 patients (60.3 vs 55.4 years, respectively). Clinical presentation with subarachnoid hemorrhage was less common in group 1. Nine group 1 patients (82%) had left-sided craniotomies, and the ipsilateral aneurysm was larger than the contralateral aneurysm. All aneurysms were clipped without intraoperative complications (136 aneurysms). Mean neurosurgical charges were decreased by contralateral MCA aneurysm clipping: $39 297 in group 1 vs $57 977 in group 2.
Contralateral MCA aneurysm clipping can be viewed as an extreme microsurgical technique or as a less invasive technique that spares patients a second craniotomy in the management of bilateral aneurysms. This technique is acceptable in selected patients with contralateral aneurysms that are unruptured, have simple necks, project inferiorly or anteriorly, are associated with short M1 segments, and reside in older patients with sylvian fissures widened by brain atrophy.
夹闭大脑中动脉（MCA）对侧动脉瘤似乎很危险且不被建议，但由于 MCA 动脉瘤的高发率、血管内治疗的局限性以及对微创技术兴趣的增加，这种技术可能成为一种重要的技术。
定义夹闭对侧 MCA 动脉瘤的患者选择、手术技术和结果。
42 例双侧 MCA 动脉瘤患者分别采用单次开颅手术夹闭对侧动脉瘤（1 期组，11 例）或双侧开颅手术（2 期组，31 例）进行治疗。手术技术包括同侧侧裂分劈、眶额下外侧入路、对侧侧裂分劈、内侧眶额叶的游离以及对侧动脉瘤夹闭。
1 期组患者的年龄大于 2 期组（分别为 60.3 岁和 55.4 岁）。1 期组患者蛛网膜下腔出血的临床表现较少见。9 例 1 期组患者（82%）行左侧开颅术，且同侧动脉瘤大于对侧动脉瘤。所有动脉瘤均在无术中并发症的情况下夹闭（136 个动脉瘤）。通过夹闭对侧 MCA 动脉瘤，1 期组的神经外科费用降低：39297 美元比 2 期组的 57977 美元。
夹闭对侧 MCA 动脉瘤可被视为一种极端的显微外科技术，也可被视为一种微创技术，可避免患者在处理双侧动脉瘤时接受第二次开颅手术。这种技术在具有以下特征的选择患者中是可以接受的：对侧未破裂、颈短、向下方或前方突出、M1 段较短、存在因脑萎缩而增宽的侧裂的未破裂动脉瘤，并且患者年龄较大。
