Microsurgical removal of previously placed aneurysm clips and application of new clips for recurrent cerebral aneurysms

Technical note

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✓ A technique is described for removing previously placed aneurysm clips and applying new aneurysm clips for the treatment of regrown or reruptured cerebral aneurysms in patients more than 10 years after the original clipping of the aneurysm neck. The adherent tissue covering previously placed clips is cut just on and alongside the clips themselves using a small scalpel. Using the clip applicator, gentle pressure is applied to open the clip blade as little as possible. The aneurysm clip is carefully slid out along the line where the clip blade has resided, and a new aneurysm clip is applied. The procedure was successfully accomplished in four patients. Whereas three of these patients had an uneventful postoperative course, the remaining patient experienced transient right oculomotor nerve palsy and left-sided motor weakness. The present technique is a useful procedure for treatment of regrown or reruptured cerebral aneurysms occurring a significantly long time after initial clipping of an aneurysm neck.

Article Information

Address correspondence to: Hiroshi Kashimura, M.D., Department of Neurosurgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan. email: hkashi@iwate-med.ac.jp.

© AANS, except where prohibited by US copyright law.

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Figures

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    Intraoperative photographs of the second surgery in a 45-year-old woman (Case 1) with a ruptured basilar artery (BA) aneurysm (AN) and regrown anterior communicating artery aneurysm 11 years after the first surgery. A: The trunk of the basilar artery is exposed. A previously placed aneurysm clip covered with adherent tissue is located at the basilar tip. B: The adherent tissue covering the clip is cut just on and alongside the clip itself using a small scalpel. C: The clip blade is slightly opened using the clip applicator. D: A regrown basilar tip aneurysm and perforating arteries are visible. E: A new aneurysm clip is applied. CNII = optic nerve; ICA = internal carotid artery; PCA = posterior cerebral artery; Th = thalamoperforating artery.

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    Preoperative (upper) and postoperative (lower) antero-posterior left vertebral angiograms in a 45-year-old woman (Case 1) with a ruptured basilar artery aneurysm and a regrown anterior communicating artery aneurysm 11 years after her initial surgery. Upper: The basilar tip aneurysm is indicated (arrow). Lower: Resolution of the aneurysm is demonstrated.

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