학술논문
A Step-by-Step Dissection of Cerebral Pathologies for Neurosurgical Trainees: The Middle Cerebral Artery Bifurcation Aneurysm.
Document Type
Academic Journal
Author
Sannwald LW; Department of Neurosurgery, Vivantes Klinikum im Friedrichshain, Berlin, Berlin, Germany.; Moskopp ML; Department of Neurosurgery, Vivantes Klinikum im Friedrichshain, Berlin, Berlin, Germany.; Institute of Physiology, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Sachsen, Germany.; Moskopp D; Department of Neurosurgery, Vivantes Klinikum im Friedrichshain, Berlin, Berlin, Germany.
Source
Publisher: Thieme Country of Publication: Germany NLM ID: 101580767 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2193-6323 (Electronic) Linking ISSN: 21936315 NLM ISO Abbreviation: J Neurol Surg A Cent Eur Neurosurg Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Aneurysmal subarachnoid hemorrhage remains one of the most prevalent causes of strokes in the young causing a high socioeconomic damage. Both emergent and elective treatments of intracranial aneurysms remain essential challenges for neurovascular centers. We aim to present conceptual education on clip ligation of middle cerebral artery bifurcation aneurysms in an accessible and structured way to maximize the educational takeaway of residents from aneurysm cases.
Methods: After 30 years of experience of the senior author in cerebrovascular surgery in three centers, we closely reviewed an exemplary case of elective right middle cerebral artery bifurcation aneurysm clipping and contrasted it to an alternative microneurosurgical approach to illustrate key principles of microneurosurgical clip ligation for neurosurgical trainees.
Results: Dissection of the sylvian fissure, subfrontal approach to the optic-carotid complex, proximal control, aneurysm dissection, dissection of kissing branches, dissection of aneurysm fundus, temporary and permanent clipping, as well as aneurysm inspection and resection are highlighted as key steps of clip ligation. This proximal-to-distal approach is contrasted to the distal-to-proximal approach. Additionally, general principles of intracranial surgery such as use of retraction, arachnoid dissection, and draining of cerebrospinal fluid are addressed.
Conclusion: Due to a constantly decreasing case load in the era of neurointerventionalism, the paradox of facing increased complexity with decreased experience must be met with a sophisticated practical and theoretical education of neurosurgical trainees early on and with a low threshold.
Competing Interests: None declared.
(Thieme. All rights reserved.)
Methods: After 30 years of experience of the senior author in cerebrovascular surgery in three centers, we closely reviewed an exemplary case of elective right middle cerebral artery bifurcation aneurysm clipping and contrasted it to an alternative microneurosurgical approach to illustrate key principles of microneurosurgical clip ligation for neurosurgical trainees.
Results: Dissection of the sylvian fissure, subfrontal approach to the optic-carotid complex, proximal control, aneurysm dissection, dissection of kissing branches, dissection of aneurysm fundus, temporary and permanent clipping, as well as aneurysm inspection and resection are highlighted as key steps of clip ligation. This proximal-to-distal approach is contrasted to the distal-to-proximal approach. Additionally, general principles of intracranial surgery such as use of retraction, arachnoid dissection, and draining of cerebrospinal fluid are addressed.
Conclusion: Due to a constantly decreasing case load in the era of neurointerventionalism, the paradox of facing increased complexity with decreased experience must be met with a sophisticated practical and theoretical education of neurosurgical trainees early on and with a low threshold.
Competing Interests: None declared.
(Thieme. All rights reserved.)