Objective:To investigate the surgical strategies for securing the middle cerebral artery(MCA)horizontal segment(M1)and surgical nuances for dissecting the sylvian fissure.Methods:A total of 112 patients with middle cerebral bifurcation aneurysms treated surgically were included.Medical re-cords,preoperative imaging studies,and surgical techniques were reviewed retrospectively.Results:The mean age in our series was 51.2 years(range:36-81 years).There was a female preponderance(female-male ratio=1.87).Of all the 112 cases,49 suffered from left MCA bifurcation aneurysms,while the others(63 cases)suffered from the right side.Subarachnoid hemorrhage was identified in 42(37.5%)patients.The upward convex course of MCA M1 segments was identified in 77 cases(68.8%)based on preoperative digital subtraction angiography(A-P view)or computed tomography angiography(coronal view),followed by the straight M1 24 cases(21.4%).The down convex M1 segments were found in 11 cases(9.8%).During surgery,M1 were secured from the dorsal side in 75 patients(67%),while the remaining 37 cases(33.0%)were secured from the ventral side.In upward convex group,there were 63 cases(81.8%)in which M1 were secured from dorsal side.Ventral con-trol of M1 were identified in 15 cases(62.5%)in the straight group and 8 cases(72.7%)in down con-vex group respectively.Neither venous infarction nor intra-operative aneurysm rupture resulting from surgery was found in our cohort.Conclusion:In the upward convex M1 group,proximal control from the dorsal side of M1 can be safely achieved in the majority of cases.Additional proximal sylvian fis-sure dissection can be applied to secure ventral M1 when it is difficult to control the parent artery in the distal sylvian fissure approach.
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