MCA Aneurysm: Aneurysmorrhaphy

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This media also describes clip ligation of classic MCA aneurysms, and also emphasizes the use of bipolar Aneurysmorrhaphy or remodeling of the sack for more precise clip application. This is a 65 year-old female who presented with an incidental eight-millimeter left-sided MCA bifurcation aneurysm. The aneurysm is relatively typical of an MCA bifurcation aneurysm pointing laterally. Patient underwent a left front temporal craniotomy. This is one of my older videos when we used fixed retractors. You can see the aneurysm sack is quite bulbous. A temporary clip was placed and the bulbous midsection of the aneurysm was reduced using bipolar coagulation. Obviously the neck was spared. The neck was circumferentially dissected so that a clip can be effectively placed across the neck. Here's replacement of a clip light, the temporary clip lights. Here's further reduction in the aneurysm girth, so that adequate visualization of the neck is possible during clip application. You can see very gentle coagulations applied under temporary M1 occlusion. Initially a curved clip was attempted, didn't appear to do the job. Next, I attempted a longer curved clip coming from the right side. This angle of clip application appears more favorable. I manipulate the dome to assure complete exclusion of aneurysm neck, and preservation of the origin of the M2 trunks. There is sizable atrium for the area of the bifurcation to avoid any stenosis of the origin of the M2 trunks. Let's go ahead and perform an intraoperative ICG angiogram. There was some question of maybe minimal filling of the aneurysm SAC. Therefore I placed a complimentary curve clip, just distal to the initial clip. And a repeat ICG angiogram was completed. You can see no filling as apparent and the post operative angiogram confirmed complete exclusion of the aneurysm and the post operative CT study revealed no evidence of ischemia. Thank you.

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