Optimum Sylvian Fissure Dissection Needed for Anterior Circulation Aneurysms, MOHAMED
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- Category: Vol. 84, June 2016
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Optimum Sylvian Fissure Dissection Needed for Anterior Circulation Aneurysms, MOHAMED A. GABR, NASSER F. EL-GHANDOR, KHALED S. ANBAR, AMR EL-TAYEB and AHMED ZAATER
Abstract
Background: Pterional transsylvian approach was opti-mized when the dissection of the sylvian fissure extended to the anterior ascending ramus and that further splitting yielded no additional gain. The point where the ascendant ramus arises anatomically corresponds to the sylvian point. This study was applied in cases with rupture aneurysm where the brain is more friable, the blood obscures the fissure and its contents.
Objective: In this study, the optimum exposure was achieved by dissection of sylvian fissure till anterior ascending ramus whatever dissection started distally in sylvian fissure or by reaching optic carotid cistern earlier.
Patients and Methods: This study carried on 20 patients admitted in Cairo University Hospitals with rupture anterior circulation aneurysms requiring surgical clipping through pterional transsylvian approach providing some brain relaxation and early proximal control of the aneurysm by opening the opticocarotid cistern first, then distal fissure is dissected.
Results: Optimum exposure and clipping by reaching the anterior ascending ramus in 12 patients (60%). However, the number of the patient needed dissection distal to Anterior Ascending Ramus (AAR) was 8 patients (40%).
Conclusion: Optimum exposure in sylvian fissure dissec-tion for rupture anterior circulation aneurysm is achieved by reaching anterior ascending ramus ,further dissection distal to anterior ascending ramus provided no additional gain in exposure.