Optimum sylvian fissure dissection needed for anterior circulation aneurysm / Mohamed Ahmed Sayed Ahmed Gabr ; Supervised Nasser Elghandour , Khaled Anbar , Mohamed Amr Eltayeb

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Neurosurgery

Pterional transsylvian approach was optimized when the dissection of the sylvian fissure extended to the anterior ascending ramus and that further splitting yielded no additional gain. The point where the ascendant ramus arises anatomically corresponds to the sylvian point. This study was applied in cases with rupture aneurysm where the brain is more friable, the blood obscures the fissure and its contents. In this study, the optimum exposure was achieved by dissection of sylvian fissure till anterior ascending ramus whatever dissection started distally in sylvian fissure or by reaching optic carotid cistern earlier. This study carried on 30 patients admitted in Cairo university hospitals with rupture anterior circulation aneurysms requiring surgical clipping through pterional transsylvian approach sylvian fissure dissection started at (point 15), which is 15 mm on sylvian fissure from sphenoid ridge followed by distal dissection or started with combined approach of sylvian fissure dissection, providing some brain relaxation and early proximal control of the aneurysm by opening the opticocarotid cistern first, then distal fissure is dissected. Optimum exposure and clipping by reaching the anterior ascending ramus in 21 patients (70%). However, the number of the patient needed dissection distal to anterior ascending ramus was 9 patients (30%). Only 8 patients (26.7%), the surgeon started dissection at point 15 because most of surgeons prefer to identify and open the opticocarotid cistern, however surgeons who start dissection at point 15 confirmed optimum splitting of sylvian fissure at this point

Issued also as CD