Aneurysms at Middle Cerebral “Trifurcation”: Treatment with Adherent Plastics

F THE various intracranial arterial aneurysms, those of the middle cerebral artery have been among the least suitable for treatment by exclusion from the circulation. In the 13 consecutive cases reported here, each has involved the main trunk of the vessel and one or more of its major branches. In the author's opinion, none of these could have been treated by the placement of a clip or clips which would have excluded the entire sac from the arterial pressure, without sacrifice of one or more significant branches. It gocs without saying that trapping of aneurysms of the middle cerebral artery rarely can be done without producing cerebral infarction, usually with important neurological deficit. We usually have been content, therefore, to obliterate with clips a portion of the sac, leaving those portions necessary for the maintenance of arterial flow, and wrapping the lot with muscle, fascia or gauze. Reasonable success has been attained by this method, but aneurysms in this location appeared to be ideally suited to treatment by adherent plastics. 1,2 Since this method provides immediate reinforcement, does not compromise the lumen of the artery and appears to eliminate the possibility that a subsequent hemorrhage will produce a false aneurysm, it was decided to treat a series of aneurysms of the middle cerebral artery by the two-coat technique, previously described by Selverstone and Ronis3 This technique provides a coat which is intimately adherent to the adventitia of the aneurysm and adjacent vessels, eliminating the possibility that hemorrhage may occur later into a potential dead space between the aneurysm and the reinforcing coat. Thirteen such aneurysms have been so