Clinical analysis of the simultaneous clipping of bilateral middle cerebral artery aneurysms via the unilateral pterional approach

The aim of this study was to investigate the feasibility of the simultaneous clipping of bilateral middle cerebral artery aneurysms via the unilateral pterional approach in Asian patients. The study included 10 cases of bilateral middle cerebral artery aneurysms, including two males and eight females; the ratio of male to female patients was 1:4. The patients ranged in age from 44 to 67 years old. All 10 patients had onsets of subarachnoid hemorrhage; the Hunt-Hess grades after onset included seven cases of grade II and three cases of grade III. Computed tomographic arteriography (CTA) was performed, and the patients were diagnosed as having bilateral middle cerebral artery aneurysms. The surgery used a pterional approach, and the clipping of the bilateral middle cerebral artery aneurysm was performed from the side of the ruptured aneurysm. Postoperative patient assessments were conducted using Glasgow Outcome Scale (GOS) scores, and CTA was used for the reexaminations. All 10 cases of bilateral middle cerebral artery aneurysms were successfully clipped. All of the patients recovered well and were discharged. The GOS scores at the half-year follow-ups included nine cases of 5 points and one case of 4 points. The CTA checks at the halfto one-year follow-ups showed that the clippings of the aneurysms at the bifurcation of the bilateral middle cerebral arteries were complete and that there were no remnants at the necks of the aneurysms. At the two-year follow-up phone calls, the GOS scores of the case with the previous GOS score of 4 had increased to 5. The cases were retrospectively analyzed to investigate the degree of brain swelling, the length of the M1 segment, the size of the aneurysm, and the impact of the orientation of the aneurysm on the clipping of contralateral middle cerebral artery aneurysms. The results suggest that in appropriate cases, the simultaneous clipping of bilateral middle cerebral artery aneurysms via the unilateral pterional approach is feasible in Asian patients.