A literature review for determining the pros and cons of mirror middle cerebral artery aneurysms (MMA) clipping through unilateral craniotomy, discussing highlights in patient selection for this procedure and representing surgical procedure and outcomes in our experience.

A literature review for determining the pros and cons of mirror middle cerebral artery aneurysms (MMA) clipping through unilateral craniotomy, discussing highlights in patient selection for this procedure and representing surgical procedure and outcomes in our experience.

The study included all patients who underwent vascular imaging for spontaneous SAH and had MMA. The surgical approach was performed from the side of the ruptured aneurysm. In favorable situations, the opposite side was clipped through arachnoid dissection of chiasmatic and contralateral sylvian cisterns (figures 1 to 3; video demonstrations of the surgical procedure will be available on presentation).

A total of 12 MCA mirror aneurysms in 6 patients were operated by unilateral frontotemporal craniotomy. The mean aneurysm size on the contralateral side was 7 mm. The average time from clipping the first aneurysm to clipping the opposite side was 42 minutes. In none of the cases, premature rupture of the second aneurysm occurred, and postoperative investigations revealed that there was no remnant in any of them. Only in one patient, anosmia developed after surgery, which seems to be due to bilateral damage to olfactory nerves during surgery.

MMA clipping through unilateral craniotomy lessens total duration of hospital stay, cost and psychological impact; However, due to risk of more retraction injury, it is not recommended in unfavorable situations such as severe brain edema, lateral projection of contralateral aneurysm, its size more than 15 mm or contralateral total A1-M1 length more than 35 mm.