Cotton-Clipping Technique to Repair Intraoperative Aneurysm Neck Tear: A Technical Note

Abstract Background: Intraoperative rupture of an intracranial aneurysm is a potentially devastating but avoidable and manageable complication of aneurysm surgery. Objective: To describe a surgical technique that the authors have used successfully to repair a tear at the neck of an intracranial aneurysm, as well as alternative options for managing this intraoperative complication. Methods: The tear on the neck of the aneurysm is covered with a small piece of free cotton and held in place with a suction device to clear the field of blood. The cotton is then clipped onto the tear with an aneurysm clip, using the cotton as a bolster to obliterate the tear. The cotton increases the surface area, allowing the clip to be placed more distally on the neck to preserve patency of the parent artery. Case examples are used to illustrate the technique. Results: Both authors independently have used this technique on several occasions to successfully repair tears at the neck of an aneurysm. Conclusion: Intraoperative rupture of an intracranial aneurysm is a potentially devastating complication, particularly if a tear occurs at the neck. This simple yet effective method has been very useful in repairing a partial avulsion or tear of the neck of an aneurysm.

Download Full-text

Repair of intraoperative aneurysm neck tear utilizing the cotton-clipping technique

Neurosurgical FOCUS ◽

10.3171/2015.v1.focus14556 ◽

2015 ◽

Vol 38 (videosuppl1) ◽

pp. Video14 ◽

Cited By ~ 1

Author(s):

Sam Safavi-Abbasi ◽

Hai Sun ◽

Mark E. Oppenlander ◽

Peter Nakaji ◽

M. Yashar S. Kalani ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Suction Device ◽

Aneurysm Clip ◽

Aneurysm Neck ◽

Link Type ◽

Clipping Technique ◽

Intraoperative Rupture

Intraoperative rupture of an intracranial aneurysm is a potentially devastating but controllable complication. The authors have successfully used the previously described cotton-clip technique to repair tears at the necks of aneurysms.1–4 A tear on the neck of the aneurysm is covered with a piece of cotton and held in place with a suction device. The cotton is then clipped onto the tear with an aneurysm clip, using the cotton as a bolster. This simple, effective method has been useful in repairing a partial avulsion of the neck of an aneurysm.1,3The video can be found here: http://youtu.be/nT86RYVQWpc.

Download Full-text

Intraoperative Rupture and Parent Artery Injury During Aneurysm Surgery

Complications in Neurosurgery ◽

10.1016/b978-0-323-50961-9.00009-8 ◽

2019 ◽

pp. 37-42

Author(s):

Brian M. Howard ◽

Daniel L. Barrow

Keyword(s):

Parent Artery ◽

Aneurysm Surgery ◽

Artery Injury ◽

Intraoperative Rupture

Download Full-text

Use of Sundt Clip Graft for the Treatment of Intracranial Aneurysms: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab056 ◽

2021 ◽

Vol 20 (5) ◽

pp. E362-E362

Author(s):

Lorenzo Rinaldo ◽

Fredric B Meyer ◽

Jamie J Van Gompel

Keyword(s):

Intracranial Aneurysm ◽

American Association ◽

Animal Experiments ◽

Side Wall ◽

Anterior Communicating Artery ◽

Aneurysm Surgery ◽

Aneurysm Neck ◽

Video Recordings ◽

Initial Surgery ◽

Potential Applications

Abstract Dr Thoralf Sundt III joined the department of neurosurgery at Mayo Clinic in 1969 and served as chairman from 1980 until his death in 1992. Dr Sundt was a pioneer in the field of cerebrovascular neurosurgery and among his many contributions to neurosurgical technology was the introduction of the Sundt clip graft (Codman, Raynham, Massachusetts), which was developed in partnership with Dr George Kees. This device is a vessel-encircling Teflon or Dacron graft loaded on a circular metallic spring initially designed to repair injuries to vessel walls during intracranial aneurysm surgery,1 which was not an uncommon complication resulting from the use of contemporary aneurysm clips.2 When used for this purpose, the clip graft has demonstrated both safety and efficacy in a modern series of surgical treatment of intracranial aneurysm.3 An additional application of the clip graft is the direct clipping of aneurysms, particularly side-wall aneurysms, though Dr Sundt recognized that the potential to occlude perforating arteries adjacent to the aneurysm neck would limit the general use of the clip graft for aneurysm clipping.2 In the following video, we present archival footage of Dr Sundt utilizing the Sundt clip graft during intracranial aneurysm surgery. The 3 cases are of the treatment of posterior communicating, middle cerebral, and anterior communicating artery aneurysms and depict the potential applications of the clip graft during aneurysm surgery. We also present footage of animal experiments Dr Sundt performed to validate the use of the clip graft. This footage likely represents some of the first microscopic neurosurgical recordings ever made. The patients consented to the procedure and to presentation of video recordings at the time of initial surgery. Image of Sundt at 0:11, Reproduced with permission from the American Association of Neurological Surgeons, 5550 Meadowbrook Dr, Rolling Meadows, IL 60008. Figures at 2:26 and 2:28, from Park PJ, Meyer FB, The Sundt clip graft, Neurosurgery, 2010;66(6 suppl operative):300-305, by permission of the Congress of Neurological Surgeons. Figure at 2:35, ©2009 Mayo, Clingman. Used with permission.

Download Full-text

Scaled Suction for Microneurosurgery: Technical Note

Operative Neurosurgery ◽

10.1227/01.neu.0000176704.30219.37 ◽

2005 ◽

Vol 57 (suppl_4) ◽

pp. ONS-E413-ONS-E413 ◽

Cited By ~ 1

Author(s):

Yoshikazu Okada ◽

Takakazu Kawamata ◽

Mikhail F. Chernov ◽

Tomokatsu Hori

Keyword(s):

Brain Tumor ◽

Tumor Size ◽

Lesion Size ◽

Technical Note ◽

Suction Device ◽

Aneurysm Neck ◽

Neck Width ◽

The Brain

Abstract OBJECTIVE: We have developed scaled suction to facilitate the measurement of aneurysm neck width and tumor size during operations. METHODS: We constructed a new suction device scaled every 1 mm from the tip to 3 cm and every 5 mm from 3 to 5 cm. The scaled suction devices have been used in 50 aneurysm and brain tumor operations. RESULTS: The new suction device permits easy measurement of aneurysm neck width, tumor size, the extent of internal decompression of tumor, and depth from the surface of the brain to the lesion. CONCLUSION: Our scaled suction device is a simple and useful navigator for continuously measuring intraoperative variables such as lesion size and distance between the lesion and the surrounding vital structures.

Download Full-text

Adenosine for Temporary Flow Arrest During Intracranial Aneurysm Surgery: A Single-Center Retrospective Review

Neurosurgery ◽

10.1227/neu.0b013e318226632c ◽

2011 ◽

Vol 69 (4) ◽

pp. 815-821 ◽

Cited By ~ 52

Author(s):

Bernard R Bendok ◽

Dhanesh K Gupta ◽

Rudy J Rahme ◽

Christopher S Eddleman ◽

Joseph G Adel ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Scale Score ◽

Arterial Occlusion ◽

Cardiac Complications ◽

Modified Rankin Scale ◽

Aneurysm Surgery ◽

Microsurgical Clipping ◽

Acute Changes ◽

Intraoperative Rupture

Abstract BACKGROUND: Clip application for temporary occlusion is not always practical or feasible. Adenosine is an alternative that provides brief periods of flow arrest that can be used to advantage in aneurysm surgery, but little has been published on its utility for this indication. OBJECTIVE: To report our 2-year consecutive experience with 40 aneurysms in 40 patients for whom we used adenosine to achieve temporary arterial occlusion during aneurysm surgery. METHODS: We retrospectively reviewed our clinical database between May 2007 and December 2009. All patients who underwent microsurgical clipping of intracranial aneurysms under adenosine-induced asystole were included. Aneurysm characteristics, reasons for adenosine use, postoperative angiographic and clinical outcome, cardiac complications, and long-term neurological follow-up with the modified Rankin Scale were noted. RESULTS: Adenosine was used for 40 aneurysms (10 ruptured, 30 unruptured). The most common indications for adenosine were aneurysm softening in 17 cases and paraclinoid location in 14 cases, followed by broad neck in 12 cases and intraoperative rupture in 6 cases. Troponins were elevated postoperatively in 2 patients. Echocardiography did not show acute changes in either. Clinically insignificant cardiac arrhythmias were noted in 5 patients. Thirty-six patients were available for follow-up. Mean follow-up was 12.8 months. The modified Rankin Scale score was 0 for 29 patients at the time of the last follow-up. Four patients had an modified Rankin Scale score of 1, and scores of 2 and 3 were found in 2 and 1 patients, respectively. CONCLUSION: Adenosine appears to allow safe flow arrest during intracranial aneurysm surgery. This can enhance the feasibility and safety of clipping in select circumstances.

Download Full-text

In situ suturing of a post-meatal segment of the anterior inferior cerebellar artery dissected by an aneurysm: A technical note

The Neuroradiology Journal ◽

10.1177/1971400920964717 ◽

2020 ◽

pp. 197140092096471

Author(s):

Kun Hou ◽

Kan Xu ◽

Yunbao Guo ◽

Jinlu Yu

Keyword(s):

Small Diameter ◽

Postoperative Recovery ◽

Technical Note ◽

Anterior Inferior Cerebellar Artery ◽

Parent Artery ◽

Acute Ischaemia ◽

Aneurysm Neck ◽

Aneurysm Wall ◽

Cerebellar Artery

Aneurysms originating along the peripheral portion of the anterior inferior cerebellar artery (AICA) are rare entities. As a result of the small diameter of the AICA, it is very challenging to preserve the parent artery during endovascular treatment for a peripheral AICA aneurysm. In this report, we present a rare case of aneurysm in the a2 segment of the right AICA. During surgery, the aneurysm was found to be a dissecting aneurysm. As the tissue of the aneurysm neck had a similar thickness to that of the adjacent normal vessel, interrupted suturing of the vessel was performed after partial removal and trimming of the aneurysm wall. The patient experienced an uneventful postoperative recovery. No other neurological deficit was noted. Magnetic resonance imaging three days after surgery revealed no acute ischaemia in the brainstem and cerebellum. Catheter angiography nine months later showed no recurrence of the aneurysm or stenosis of the AICA. The a2 segment of the AICA runs tortuously along the subarachnoid space of the cerebellopontine angle, which permits higher vascular mobility. In selected cases, in situ suturing or re-anastomosis could be considered for a2 segment aneurysms.

Download Full-text

Cotton-Clipping Technique to Repair Intraoperative Aneurysm Neck Tear: A Technical Note

Neurosurgery ◽

10.1227/neu.0b013e31822dfe02 ◽

2011 ◽

pp. 1

Author(s):

Daniel L Barrow ◽

Robert F Spetzler

Keyword(s):

Technical Note ◽

Aneurysm Neck ◽

Clipping Technique

Download Full-text

Endaneurysmal Microendarterectomy in the Treatment of Giant Cerebral Aneurysms: Technical Note

Neurosurgery ◽

10.1227/00006123-198811000-00027 ◽

1988 ◽

Vol 23 (5) ◽

pp. 674-679 ◽

Cited By ~ 10

Author(s):

Phillip D. Hylton ◽

O. Howard Reichman

Keyword(s):

Cerebral Aneurysms ◽

Giant Aneurysm ◽

Technical Note ◽

Parent Artery ◽

Operative Techniques ◽

Aneurysm Neck ◽

Clip Application ◽

Technical Challenges

Abstract Giant cerebral aneurysms continue to present the surgeon with substantial technical challenges. Operative techniques for managing giant cerebral aneurysms are becoming increasingly sophisticated. We emphasize in this report a technique for direct obliteration of the giant aneurysm with a hard, calcified atheroma at its base that prevents direct clip application without compromise of the parent artery. Temporary trapping of the aneurysm, intramural thrombectomy, and endaneurysmal microendarterectomy allow direct obliteration of the aneurysm neck with preservation of the parent artery.

Download Full-text