Double-clip technique for the microneurosurgical management of very small (< 3 mm) intracranial aneurysms.
Neurosurgery 2014;
11 Suppl 2:3-7. [PMID:
25251196 DOI:
10.1227/neu.0000000000000557]
[Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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.
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