Limitation of fenestrated clips during clipping of middle cerebral artery aneurysm: Technical note

The middle cerebral artery (MCA) is a common site of cerebral aneurysms and 82.6% occur at the bifurcation. When surgery is selected as a therapeutic option, it intends to clip the neck completely because if some remnant occurs, there exists the possibility of regrowth and bleeding in the short- or...

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Published inSurgical neurology international Vol. 14; p. 204
Main Authors Degollado-García, Javier, Rodríguez-Rubio, Héctor A, Bonilla-Suastegui, Alfredo, Serrano-Rubio, Alejandro, Nicolas-Cruz, Carlos F, Nathal, Edgar
Format Journal Article
LanguageEnglish
Published United States 2023
Subjects
Aneurysm remnant
Cerebral aneurysm
Clipping surgery
Closure line technique
Middle cerebral artery
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Summary:The middle cerebral artery (MCA) is a common site of cerebral aneurysms and 82.6% occur at the bifurcation. When surgery is selected as a therapeutic option, it intends to clip the neck completely because if some remnant occurs, there exists the possibility of regrowth and bleeding in the short- or long-term. We analyzed one drawback of the fenestrated clips of Yasargil and Sugita types to occlude the neck totally at a specific point formed by the union of the fenestra with the blades, creating a triangular space where the aneurysm can protrude, giving place to a remnant that can lead to a future recurrence and rebleeding. We show two cases of ruptured MCA aneurysms in which a cross-clipping technique occluded a broad base and dysmorphic aneurysm using straight fenestrated clips. In both cases (one using a Yasargil clip and the other with a Sugita clip), a small remnant was visualized when fluorescein videoangiography (FL-VAG) was used. In both cases, the small remnant was clipped with a 3 mm straight miniclip. We should be aware of this drawback when clipping aneurysms using fenestrated clips to ensure a complete obliteration of the aneurysm's neck.
ISSN:2229-5097