Double-clip technique for the microneurosurgical management of very small (< 3 mm) intracranial aneurysms.

Abstract

BACKGROUND:

The treatment of very small (≤ 3 mm) aneurysms is technically challenging. Mini-clips used for clipping these small aneurysms have a smaller closing force compared with standard clips.

OBJECTIVE:

To describe the double-clip technique for very small aneurysms.

METHODS:

The double-clip technique, a parallel duplication clipping technique of booster clipping, is used by the senior author for clipping very small aneurysms with morphology suitable for the application of 2 clips. The aneurysm is clipped after application of temporary clip(s), administration of adenosine, or both. An initial mini-clip is applied, leaving a small residual neck sufficient for application of the second mini-clip. A second mini-clip of the same size and shape is applied on the residual neck parallel to the initial clip. The initially applied mini-clip, which is in close contact with the second clip, supports the second clip and prevents its slippage. This technique was retrospectively reviewed over a 13-year period (1997-2009). There were 3246 patients with 4757 aneurysms treated in the same period.

RESULTS:

The outcomes of 39 patients with 40 very small aneurysms clipped with the double-clip technique were analyzed. None of the patients had technique-related complications. Postoperative angiograms revealed complete aneurysm occlusion of 39 aneurysms and a small residual neck in 1 aneurysm. No parent artery obstruction was observed in the postoperative angiogram.

CONCLUSION:

The double-clip technique is a safe and effective variation of booster clipping in the treatment of very small aneurysms with suitable morphology.

• Authors: Narayanam Anantha Sai Kiran, Behnam Rezai Jahromi, Joham Choque Velasquez, Ferzat Hijazy, Felix Goehre, Riku Kivisaari, Chaiyot Siangprasertkij, Luis Francisco Munoz Gallegos, Hanna Lehto, Juha Hernesniemi
• Journal: Neurosurgery (Neurosurgery) Vol. 11 Suppl 2 Pg. 3-7 (Mar 2015) ISSN: 1524-4040 [Electronic] United States
• PMID: 25251196 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Intracranial Aneurysm (diagnostic imaging, pathology, surgery)
• Male
• Microsurgery (instrumentation, methods)
• Middle Aged
• Neurosurgical Procedures (instrumentation, methods)
• Radiography
• Retrospective Studies
• Treatment Outcome
• Vascular Surgical Procedures (instrumentation, methods)
• Young Adult