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

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.
To describe the double-clip technique for very small aneurysms.
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.
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.
The double-clip technique is a safe and effective variation of booster clipping in the treatment of very small aneurysms with suitable morphology.
AuthorsNarayanam 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
JournalNeurosurgery (Neurosurgery) Vol. 11 Suppl 2 Pg. 3-7 (Mar 2015) ISSN: 1524-4040 [Electronic] United States
PMID25251196 (Publication Type: Journal Article)
  • 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

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