1st Latin American Neurosurgery Grand Rounds; MCA Aneurysms; Surgery; Part 1; Surgery; Dr. Kléber Eduardo González Echiverria of Ecuador; Dr. Joham Choque-Velasquez; Organizer.

SUMMARY: This is the recording of the 1st Latin American International Grand Rounds with SNI Digital® and the Latin American Neurosurgeons exchanging their experiences with a world audience. This meeting was organized by Joham Choque-Velasquez, MD, PhD of Cuzco, Peru. The title of the presentations were “Management of Middle Cerebral Aneurysms: Microsurgery vs Interventional Neurosurgery.”

The first lecture discussion was given by Dr. Kléber Eduardo González Echiverria of Ecuador. Dr Gonzales-Echiverria discussed the anatomy of the Middle Cerebral vessels and his use of a Pterional or a Supra-orbital approaches related to cerebral swelling.He mentioned he uses intra-operative neuronal monitoring-evoked potentials, to help him determine the length of temporary clipping. There was a wide discussion of the use of brain protection measures for temporary clipping from none, to intermittent clip release, to chemical cardiac arrest, which Professor Hernesniemi used frequently with success. Joham describe this technique in detail and Ramisis Ghaly, a boarded neurosurgeon, anesthesiologist and Critical care and Pain specialist, commented on the use of Cardiac Arrest during aneurysm surgery. Also discussed was how to treat SAH with an aneurym and AVM.

The second lecture was given by Dr. Giancarlo Saal Zapata MD, of Lima, Peru who has a very large experience with interventional neurosurgery techniques. He presented a series of cases of MCA aneurysms and reviewed his experience with coiling , etc, which was very good. There is some selection in his series because of referrals. Yet his experience is very good. There was a wide discussion with the international audience on how each approached Middle Cerebral Aneurysm Management. Each neurosurgeon has to do what his/her environment and resources will allow, anywhere. Given the best surgeon and interventional doctor's approaches, coiling appears to be the first choice, but many factors have to be considered in each case separately. There is no consensus because there are too many variables to consider. Like for basilar tip aneurysms, intervention is the preferred choice and each aneurysm location may have a preferred choice; See SNI Digital discussion among neurosurgeons on this subject:

Excellent Discussion of a controversial topic everywhere. Best for Video; Images needed for podcast but Discussion is valuable. In two parts 60 minutes each for 120 minutes total. Need to be seen together to benefit from the Discussion. (JIA)