2023 Volume 32 Issue 2 Pages 82-90
Advances in endovascular treatment have led to a paradigm shift in the role of surgical clipping for intracranial aneurysms. Even deep-seated aneurysms can be accessed and treated relatively easily via the endovascular approach, which serves as an advantage of this method. However, surgical clipping scores over endovascular treatment for middle cerebral artery aneurysms, which is attributable to the fact that the middle cerebral artery is a shallow vessel for open surgery but peripheral for endovascular treatment. A surgically shallow operative field facilitates successful obliteration of saccular aneurysms of varied shapes, and bypass reconstruction can be performed in patients in whom trapping is feasible. Therefore, the open neurosurgeon should be aware of creation of a shallow operative field even for deep-seated aneurysms.
Development of novel endovascular devices in the future may expand the indications for the application of endovascular therapy for middle cerebral artery lesions. Open surgery is useful for treatment of aneurysms for which endovascular treatment is challenging.
In this report, we discuss selection of the optimal surgical approach and strategies for creation of a wide operative field for anterior circulation and basilar artery apex aneurysms.
