2007
DOI: 10.1055/s-2007-985153
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A Classification of Unruptured Middle Cerebral Artery Bifurcation Aneurysms that can Help in Choice of Clipping Technique

Abstract: Middle cerebral artery (MCA) aneurysms comprise 20-25% of all intracranial aneurysms. The majority of middle cerebral artery aneurysms are treated by microsurgical clipping. Most of the classifications of aneurysms at present are based on size, location or pathology which are effective for the description but are less useful in preoperative planning and also in deciding on the technique or type of clip application. The aim of our study was to examine the morphological features of unruptured MCA bifurcation ane… Show more

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Cited by 20 publications
(10 citation statements)
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“…Although other factors such as atherosclerosis, multilobulation, and presence of daughter sacs are likely to affect this selection, the choice of the clipping method can be based on the operator's own experiences with different aneurysm morphologies. In this regard, few studies have classified MCBIF aneurysms based on their morphological features, which can influence the clipping techniques or patterns by assessing the relationship between the aneurysm sac, parent vessel, and branch vessels [12,29]. In the present study, the neck of MCBIF aneurysm was determined by the degree of progression of the aneurysmal thin wall into the surrounding branch vessels.…”
Section: Discussionmentioning
confidence: 91%
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“…Although other factors such as atherosclerosis, multilobulation, and presence of daughter sacs are likely to affect this selection, the choice of the clipping method can be based on the operator's own experiences with different aneurysm morphologies. In this regard, few studies have classified MCBIF aneurysms based on their morphological features, which can influence the clipping techniques or patterns by assessing the relationship between the aneurysm sac, parent vessel, and branch vessels [12,29]. In the present study, the neck of MCBIF aneurysm was determined by the degree of progression of the aneurysmal thin wall into the surrounding branch vessels.…”
Section: Discussionmentioning
confidence: 91%
“…Although aneurysm obliteration by microsurgical clipping has been shown to have a low recurrence rate and high durability, for completeness of the procedure, the unique anatomy of the aneurysm should be considered when performing neck closure with microsurgical clips [9,12,13,29,30]. It is important to properly cover the aneurysm neck without any remnants and to preserve the normal blood flow.…”
Section: Introductionmentioning
confidence: 99%
“…While describing its role in controlling intraoperative rupture, Yasargil also cautions against the hazards of aneurysm coagulation -"excessive heating… forceps-tips stick[ing] to the aneurysm…its neck may be avulsed…perforating vessels injured"and then reinforces the importance of frequent bipolar tip cleaning, short controlled applications of cautery, proper experience with bipolar cautery on artery walls, and having several sets of forceps available [6]. Of note, bipolar coagulation will be less efficacious on calcific, atherosclerotic portions of the aneurysm complex [7], and because of the degenerative histological changes that coagulation induces, it should be avoided on the aneurysm neck at/below the site of clip placement to avoid creating a weak spot in the vessel wall that may predispose the patient to a future risk of recurrence or rupture.…”
Section: Discussionmentioning
confidence: 99%
“…The main trunk of the MCA starts at the ICA bifurcation in the sylvian cistern. The M1 segment(sphenoidal segment) runs laterally until it reaches the level of the limen insula where it splits usually into 2 branches, the superior division (upper trunk) and inferior division (lower trunk) 6). The M2 segment (insular segment) starts from the genu portion to circular sulcus and runs parallel with the insular surface, supplying blood to the insula.…”
Section: Discussionmentioning
confidence: 99%