Single-stage operation for bilateral middle cerebral artery aneurysms

Abstract

Subarachnoid haemorrhage with bilateral middle cerebral artery aneurysms is occasionally encountered in neurosurgical practice. We report upon our experiences of the single-stage operation for bilateral middle cerebral artery aneurysms (BMCA) through a bilateral subfrontal approach. During the past two and half years, we have experienced three cases of BMCAA, who were treated by this method. The whole procedure was conducted using a single-stage head positioning and draping. Slight table tilting was enough to allow the proper clipping of each aneurysm. During the past 2.5 years, 255 cases of intracranial aneurysm have been treated in our hospital. Among these, the incidence of BMCAA was 1.18% (3/255). The mean duration of operation for the three cases involved was 5.8 hours, and showed a progressive decrease with experience. All patients recovered well, and were discharged as in other uneventful aneurysm cases. The total operation time was longer, and was a little more laborious than normal single aneurysm surgery. This method has substantial advantages over "classical" skull base approaches to MCA aneurysms. As extensive frontal lobe manipulation and external facial incisions are avoided with subfrontal approaches, intensive care unit and overall hospital stay are reduced, related complications are minimized, and postoperative cosmetic appearance is enhanced.