Surgical Technique of Proximal Control in the Middle Cerebral Artery Aneurysm Clipping by Distal Sylvian Approach in Relation to the Morphological Variety of M1 Segment

ISHIKAWA, Kohei; Sasaki, Takehiko; Yamazaki, Takaaki; Moriwaki, Hiroshi; Nakanishi, Takafumi; Kojo, Takamaro; Senoo, Makoto; Shimazaki, Mitsunori; Nishiya, Mikio

doi:10.2335/scs.50.25

Cited by 1 publication

(1 citation statement)

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“…It is indisputable that Sylvian fissure arachnoid dissection is one of the most essential neurosurgical skills for neurovascular surgeons, oncologic neurosurgeons, and skull base surgeons. [1][2][3][4][5][6][7][8] Techniques of splitting Sylvian could be divided into two categories: sharp dissection by microscissors and blunt dissection by spreading the tip of bipolar forceps or probing with a microdissector. 9,10 Splitting Sylvian fissure widely has many benefits such as brain relaxation and wide surgical corridor, which lead to safer surgery, less periprocedural complications, and better neurological outcomes.…”

Section: Introductionmentioning

confidence: 99%

Training in Sylvian Arachnoid Dissection: The Art of Using Kamiyama Scissors and a Simple Novel Model for Practice Sylvian Arachnoid Dissection Using Cotton Fiber with Brain Model

Ariyaprakai,

Kusdiansah,

Degollado-García

et al. 2024

Asian J Neurosurg

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Background Transsylvian approach is one of the main approaches for a variety of vascular, tumor, and skull-base lesions. Sylvian fissure harbors a lot of critical structures including the middle cerebral artery and many venous structures. If not done properly, the transsylvian approach could cause several complications. Up to now, there is no simple training model for practicing Sylvian fissure dissection. In this article, we describe the technique of using microscissors for the sharp dissection of arachnoid trabeculae. We also propose a new model for practicing Sylvian arachnoid dissection using a three-dimensional (3D) brain model with cotton fiber. Method We inserted cotton fiber into the Sylvian fissure of the brain model (aneurysm box from UpsurgeOn) and covered the Sylvian fissure with a cotton sheet, then sprayed the water over it. We dissected this model under a microscope by using Kamiyama scissors in the right hand and suction in the left hand. Result Under the microscope, our model appears comparable with the real Sylvian fissure. We can use this model for practicing arachnoid dissection with Kamiyama scissors. Conclusion The arachnoid dissection model by using a 3D brain model with cotton fiber is a simplified and novel approach for practicing the Sylvian fissure dissection.

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