{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T06:15:33Z","timestamp":1771481733353,"version":"3.50.1"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg A Cent Eur Neurosurg"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n               Background\u2003Aneurysmal subarachnoid hemorrhage remains one of the most prevalent causes of strokes in the young causing a high socioeconomic damage. Both emergent and elective treatments of intracranial aneurysms remain essential challenges for neurovascular centers. We aim to present conceptual education on clip ligation of middle cerebral artery bifurcation aneurysms in an accessible and structured way to maximize the educational takeaway of residents from aneurysm cases.<\/jats:p><jats:p>\n               Methods\u2003After 30 years of experience of the senior author in cerebrovascular surgery in three centers, we closely reviewed an exemplary case of elective right middle cerebral artery bifurcation aneurysm clipping and contrasted it to an alternative microneurosurgical approach to illustrate key principles of microneurosurgical clip ligation for neurosurgical trainees.<\/jats:p><jats:p>\n               Results\u2003Dissection of the sylvian fissure, subfrontal approach to the optic-carotid complex, proximal control, aneurysm dissection, dissection of kissing branches, dissection of aneurysm fundus, temporary and permanent clipping, as well as aneurysm inspection and resection are highlighted as key steps of clip ligation. This proximal-to-distal approach is contrasted to the distal-to-proximal approach. Additionally, general principles of intracranial surgery such as use of retraction, arachnoid dissection, and draining of cerebrospinal fluid are addressed.<\/jats:p><jats:p>\n               Conclusion\u2003Due to a constantly decreasing case load in the era of neurointerventionalism, the paradox of facing increased complexity with decreased experience must be met with a sophisticated practical and theoretical education of neurosurgical trainees early on and with a low threshold.<\/jats:p>","DOI":"10.1055\/s-0042-1760397","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T23:53:10Z","timestamp":1679356390000},"page":"202-214","source":"Crossref","is-referenced-by-count":2,"title":["A Step-by-Step Dissection of Cerebral Pathologies for Neurosurgical Trainees: The Middle Cerebral Artery Bifurcation Aneurysm"],"prefix":"10.1055","volume":"85","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4505-4315","authenticated-orcid":false,"given":"Lennart Wilhelm","family":"Sannwald","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Vivantes Klinikum im Friedrichshain, Berlin, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4233-3140","authenticated-orcid":false,"given":"Mats Leif","family":"Moskopp","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Vivantes Klinikum im Friedrichshain, Berlin, Berlin, Germany"},{"name":"Institute of Physiology, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, Sachsen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4173-7653","authenticated-orcid":false,"given":"Dag","family":"Moskopp","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Vivantes Klinikum im Friedrichshain, Berlin, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,3,20]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1515\/revneuro-2020-0131","article-title":"Theysiopathology of spontaneous hemorrhagic stroke: a systematic review","volume":"32","author":"A B Morais Filho","year":"2021","journal-title":"Rev Neurosci"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1056\/NEJMcp1605827","article-title":"Subarachnoid hemorrhage","volume":"377","author":"M T Lawton","year":"2017","journal-title":"N Engl J Med"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/S0140-6736(16)30668-7","article-title":"Spontaneous subarachnoid haemorrhage","volume":"389","author":"R L Macdonald","year":"2017","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1016\/S0140-6736(02)11314-6","article-title":"International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial","volume":"360","author":"A Molyneux","year":"2002","journal-title":"Lancet"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/S0140-6736(05)67214-5","article-title":"International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion","volume":"366","author":"A J Molyneux","year":"2005","journal-title":"Lancet"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"e336","DOI":"10.1016\/j.wneu.2021.02.027","article-title":"Microsurgical clipping versus advanced endovascular treatment of unruptured middle cerebral artery bifurcation aneurysms after a \u201ccoil-first\u201d policy","volume":"149","author":"M Pflaeging","year":"2021","journal-title":"World Neurosurg"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1016\/j.wneu.2015.05.073","article-title":"Comparison of the efficacy and safety of endovascular coiling versus microsurgical clipping for unruptured middle cerebral artery aneurysms: a systematic review and meta-analysis","volume":"84","author":"T R Smith","year":"2015","journal-title":"World Neurosurg"},{"key":"ref8","volume-title":"Rhoton Cranial Anatomy & Surgical Approaches","author":"A L Rhoton Jr","year":"2020"},{"key":"ref9","volume-title":"Skull Base and Related Structures","author":"J Lang","year":"2001"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.3171\/2018.2.JNS172734","article-title":"Longitudinal survey of cranial case log entries during neurological surgery residency training","volume":"130","author":"N Agarwal","year":"2018","journal-title":"J Neurosurg"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1007\/s00701-019-03888-3","article-title":"Neurosurgical procedures performed during residency in Europe-preliminary numbers and time trends","volume":"161","author":"M N Stienen","year":"2019","journal-title":"Acta Neurochir (Wien)"},{"issue":"06","key":"ref12","first-page":"1052","article-title":"A review of brain retraction and recommendations for minimizing intraoperative brain injury","volume":"33","author":"R J Andrews","year":"1993","journal-title":"Neurosurgery"},{"key":"ref13","volume-title":"Zerebroprotektive Massnahmen bei Energiekrisen des Gehirns: Behandlungsstrategien bei Erkrankungen des ZNS mit akuter Mangeldurchblutung","author":"D Moskopp","year":"1994"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1001\/archneur.1976.00500050031006","article-title":"Cerebral protection by barbiturate anesthesia. Use after middle cerebral artery occlusion in Java monkeys","volume":"33","author":"J D Michenfelder","year":"1976","journal-title":"Arch Neurol"},{"issue":"05","key":"ref15","doi-asserted-by":"crossref","first-page":"685","DOI":"10.3171\/jns.1982.56.5.0685","article-title":"Barbiturate coma in focal cerebral ischemia. Relationship of protection to timing of therapy","volume":"56","author":"W R Selman","year":"1982","journal-title":"J Neurosurg"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"79","DOI":"10.4103\/sni.sni_410_16","article-title":"Safe time duration for temporary middle cerebral artery occlusion in aneurysm surgery based on motor-evoked potential monitoring","volume":"8","author":"J Tanabe","year":"2017","journal-title":"Surg Neurol Int"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"47","DOI":"10.4103\/2152-7806.130560","article-title":"Preliminary study on safe thresholds for temporary internal carotid artery occlusion in aneurysm surgery based on motor-evoked potential monitoring","volume":"5","author":"J Tanabe","year":"2014","journal-title":"Surg Neurol Int"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1016\/j.wneu.2015.07.050","article-title":"Venous-preserving sylvian dissection","volume":"84","author":"H Maekawa","year":"2015","journal-title":"World Neurosurg"}],"container-title":["Journal of Neurological Surgery Part A: Central European Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0042-1760397.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T10:46:23Z","timestamp":1730803583000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0042-1760397"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,20]]},"references-count":18,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2024,1,31]]},"published-print":{"date-parts":[[2024,3]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0042-1760397","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2193-6315","2193-6323"],"issn-type":[{"value":"2193-6315","type":"print"},{"value":"2193-6323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,20]]}}}