Unilateral or bilateral craniotomy for the treatment of bilateral middle cerebral artery aneurysms
EANS Academy. Chung Y. 09/25/19; 275767; EP01028
Prof. Young Seob Chung
Prof. Young Seob Chung

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To compare two craniotomy approaches (unilateral and bilateral) in terms of anatomical and clinical parameters and surgical outcomes.
From January 2011 to December 2014, 19 patients with bilateral unruptured middle cerebral artery (MCA) aneurysms were treated with unilateral craniotomy (group 1) and 10 patients were treated with bilateral mini-craniotomy (group 2). We compared demographic data, characteristics of aneurysms, radiological and clinical parameters, postoperative complications, and surgical outcomes between the groups.
No statistically significant differences were found in aneurysm characteristics between the two groups. Radiological parameters did not have any influence on surgical outcomes or the incidence of postoperative complications. Group 1 had a higher incidence of olfactory dysfunction (11/19, 58%) and residual neck at the contralateral aneurysm (10/19, 53%), while group 2 did not have olfactory dysfunction or residual neck at the contralateral aneurysm. All patients in group 2 had good surgical outcomes (modified Rankin scale 0). The length of the hospital stay was similar in both groups.
Bilateral mini-craniotomy for the treatment of bilateral MCA aneurysms was associated with better surgical outcomes and fewer complications. Bilateral mini-craniotomy does not require as much retraction of the frontal lobe to apply a clip completely at the contralateral aneurysm. Therefore, it represents a safe and effective therapeutic option for unruptured bilateral MCA aneurysms.
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