Contralateral approach for middle cerebral artery aneurysms with long M1 segment: report of 2 cases.

INTRODUCTION Contralateral clipping of middle cerebral artery (MCA) aneurysms is not practiced widely and has been reported only in case series. Some of the neurosurgeons proposing this approach have even postulated that a short M1 segment is a basic requirement for performing it. CASES We present our experience using a contralateral approach with 2 patients who had 3 MCA aneurysms located more than 2.5cm from the carotid bifurcation. All 3 aneurysms were completely occluded, as demonstrated on postoperative CT angiography, and the patients' neurological evolution was uneventful. DISCUSSION The contralateral approach can be regarded as a safe and effective technique for MCA aneurysm clipping. One contraindication frequently stated is the length of the MCA M1 segment; however, our experience proves that long distances can be reached if an adequate Sylvian fissure dissection is performed. We consider that the use of a contralateral approach requires fine technical skills and should be the choice only under judicious case-to-case planning, always bearing the preferences and experience of the neurosurgeon in mind.