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

BACKGROUND: 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 th...

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Autores principales: Degollado-García, Javier, Rodríguez-Rubio, Héctor A., Bonilla-Suastegui, Alfredo, Serrano-Rubio, Alejandro, Nicolas-Cruz, Carlos F., Nathal, Edgar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Scientific Scholar 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10316142/
https://www.ncbi.nlm.nih.gov/pubmed/37404494
http://dx.doi.org/10.25259/SNI_374_2023
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author Degollado-García, Javier
Rodríguez-Rubio, Héctor A.
Bonilla-Suastegui, Alfredo
Serrano-Rubio, Alejandro
Nicolas-Cruz, Carlos F.
Nathal, Edgar
author_facet Degollado-García, Javier
Rodríguez-Rubio, Héctor A.
Bonilla-Suastegui, Alfredo
Serrano-Rubio, Alejandro
Nicolas-Cruz, Carlos F.
Nathal, Edgar
author_sort Degollado-García, Javier
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: We should be aware of this drawback when clipping aneurysms using fenestrated clips to ensure a complete obliteration of the aneurysm’s neck.
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spelling pubmed-103161422023-07-04 Limitation of fenestrated clips during clipping of middle cerebral artery aneurysm: Technical note Degollado-García, Javier Rodríguez-Rubio, Héctor A. Bonilla-Suastegui, Alfredo Serrano-Rubio, Alejandro Nicolas-Cruz, Carlos F. Nathal, Edgar Surg Neurol Int Technical Notes BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: We should be aware of this drawback when clipping aneurysms using fenestrated clips to ensure a complete obliteration of the aneurysm’s neck. Scientific Scholar 2023-06-16 /pmc/articles/PMC10316142/ /pubmed/37404494 http://dx.doi.org/10.25259/SNI_374_2023 Text en Copyright: © 2023 Surgical Neurology International https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Technical Notes
Degollado-García, Javier
Rodríguez-Rubio, Héctor A.
Bonilla-Suastegui, Alfredo
Serrano-Rubio, Alejandro
Nicolas-Cruz, Carlos F.
Nathal, Edgar
Limitation of fenestrated clips during clipping of middle cerebral artery aneurysm: Technical note
title Limitation of fenestrated clips during clipping of middle cerebral artery aneurysm: Technical note
title_full Limitation of fenestrated clips during clipping of middle cerebral artery aneurysm: Technical note
title_fullStr Limitation of fenestrated clips during clipping of middle cerebral artery aneurysm: Technical note
title_full_unstemmed Limitation of fenestrated clips during clipping of middle cerebral artery aneurysm: Technical note
title_short Limitation of fenestrated clips during clipping of middle cerebral artery aneurysm: Technical note
title_sort limitation of fenestrated clips during clipping of middle cerebral artery aneurysm: technical note
topic Technical Notes
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10316142/
https://www.ncbi.nlm.nih.gov/pubmed/37404494
http://dx.doi.org/10.25259/SNI_374_2023
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