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Ngando HM, Maslehaty H, Schreiber L, et al. Anatomical configuration of the Sylvian fissure and its influence on outcome after pterional approach for microsurgical aneurysm clipping. Surg Neurol Int. 2013;4:129doi: 10.4103/2152-7806.119073.
Ngando, H. M., Maslehaty, H., Schreiber, L., Blaeser, K., Scholz, M., & Petridis, A. K. (2013). Anatomical configuration of the Sylvian fissure and its influence on outcome after pterional approach for microsurgical aneurysm clipping. Surgical neurology international, 4129. https://doi.org/10.4103/2152-7806.119073
Ngando, Hannah M, et al. "Anatomical configuration of the Sylvian fissure and its influence on outcome after pterional approach for microsurgical aneurysm clipping." Surgical neurology international vol. 4 (2013): 129. doi: https://doi.org/10.4103/2152-7806.119073
Ngando HM, Maslehaty H, Schreiber L, Blaeser K, Scholz M, Petridis AK. Anatomical configuration of the Sylvian fissure and its influence on outcome after pterional approach for microsurgical aneurysm clipping. Surg Neurol Int. 2013 Sep 30;4:129. doi: 10.4103/2152-7806.119073. eCollection 2013. PMID: 24231790; PMCID: PMC3814910.
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Surg Neurol Int. 2013 Sep 30;4:129. doi: 10.4103/2152-7806.119073. eCollection 2013.

Anatomical configuration of the Sylvian fissure and its influence on outcome after pterional approach for microsurgical aneurysm clipping.

Surgical neurology international

Hannah M Ngando, Homajoun Maslehaty, Lutz Schreiber, Klaus Blaeser, Martin Scholz, Athanasios K Petridis

Affiliations

  1. Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg, Germany.

PMID: 24231790 PMCID: PMC3814910 DOI: 10.4103/2152-7806.119073

Abstract

BACKGROUND: The sylvian fissure (SF) is the anatomical pathway used in a pterional approach, which leads to most aneurysms. There are four different anatomical variants of the SF described. In the present retrospective study the four different categories of the SF were studied in order to evaluate any correlation of these variants to surgical outcome.

METHODS: Patients treated for intracranial aneurysms by a pterional transsylvian approach during 2003-2012 (N = 237) were included in the study. The SF category was determined by analysis of preoperative computed tomography (CT) scanning. Patients were grouped into unruptured intracranial aneurysms (UIA) and ruptured intracranial aneurysms with subarachnoid hemorrhage (SAH) according to the Hunt and Hess grades. Brain edema, vasospasms, ischemic lesion rate, and outcome were evaluated for possible correlation with SF anatomical variants.

RESULTS: Postsurgically brain edema formation correlated significantly with more complex anatomical variants of the SF in patients with UIAs and in patients with Hunt and Hess 1 and 2. Ischemia rate, vasospasms, or clinical outcome was not negatively affected though.

CONCLUSION: The classification of the SF as proposed by Yasargil is more than a pure anatomical observation. In this retrospective study, we show that the anatomical variants of the SF can be associated to postoperative complications like formation of brain edema or ischemic lesions Preoperative knowledge of the SF anatomy and possibly consecutive adapted extend of the surgical approach can decrease procedure-related morbidity.

Keywords: Aneurysm; subarachnoid hemorrhage; sylvian fissure

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