Simple MCA Aneurysm

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Here is a video describing techniques for clip ligation of a simple MCA aneurysm. This is a 61 year-old female who presented with seizures and my evaluation revealed a left-sided MCA aneurism with evidence of edema around the aneurysm. CT angiogram also demonstrated the relatively narrow neck of the aneurism. Left frontotemporal craniotomy was completed. The superficial Sylvian fissure was dissected. You can see some evidence of hemosiderin leading one to believe that this aneurysm had previously ruptured. The fissure was opened in an inside to outside technique. The aneurysm was exposed. Here you can see the M2 branches, the M1 branch located deep within the fissure. The neck of the aneurysm was circumferentially exposed. Temporary clip was used so that the temporal branch can be dissected from the neck of the aneurysm. I usually measure or evaluate flow using micro-Doppler ultrasonography within the branching vessels before the clip is applied. So I can have a relative baseline. Curve clip was used in this case. Post clipping, micro-Doppler ultrasonography have revealed good flow. Edition Fluorescein as well as ICG angiograms confirmed the findings. Aneurysm sack is no longer filling. Aneurysm dome was entered, and I confirm the aneurysm was completely excluded. Atherosclerotic aneurysms can lead to false negative fluorescence on intraoperative fluorescein angiography, and therefore their penetration can be another method to confirm their complete obliteration, postoperative angiogram in this case confirmed complete exclusion of the aneurysm. Thank you.

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