“Interlocking” Clipping of an Irregular Middle Cerebral Artery Bifurcation Aneurysm: 2-Dimensional Operative Video

“Interlocking” Clipping of an Irregular Middle Cerebral Artery Bifurcation Aneurysm:... SURGICAL VIDEO “Interlocking” Clipping of an Irregular Middle Cerebral Artery Bifurcation Aneurysm: 2-Dimensional Operative Video ∗ ∗ Thomas J. Sorenson, BS , Chris Marcellino, MD , Nicola Acciarri, ‡ ∗ § ∗ § MD ,LeonardoRangelCastilla,MD , Giuseppe Lanzino, MD ∗ ‡ Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Neurologic Surgery, Institute of Neurological Sciences of Bologna, Bologna, Italy, Department of Radiology, Mayo Clinic, Rochester, Minnesota Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy147 Correspondence: Giuseppe Lanzino, MD, Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902. E-mail: Lanzino.Giuseppe@mayo.edu Middle cerebral artery (MCA) aneurysms often have an is used to obliterate 1 portion of the aneurysm and irregular morphology that might require creative clipping a fenestrated clip, with the ring of the fenestration techniques even in the case of small aneurysms. In this circling the body of the first clip, is used to obtain video, we illustrate the case of a patient with an incidental obliteration of the other lobe. This patient also had a but very irregular MCA aneurysm. The presence of contralateral internal carotid artery occlusion, and we 2 separate, asymmetric lobes was dealt with by utilizing discuss the pitfalls of temporary clipping in such a the “interlocking” clip technique in which a regular clip situation. KEY WORDS: Middle cerebral artery, Aneurysm, Clipping, Microsurgery, Interlocking, Fenestrated clip Operative Neurosurgery 0:1, 2018 DOI:10.1093/ons/opy147 Received, January 18, 2018. Accepted, May 9, 2018. Disclosure he authors provide a good video illustration of a well-established technique for stacking multiple clips on complex or wide aneurysm The authors have no personal, financial, or institutional interest in any of the necks. As such, this video is a good teaching tool, even if it does not drugs, materials, or devices described in this article. provide novel information. Other technical and medical risks, such as the impact of a calcified neck or comorbidities that could complicate surgery or shorten life-expectancy, must be considered when applying COMMENTS this technique. In so doing, the surgeon may carefully weigh these risks against other possible outcomes such as incomplete aneurysm occlusion he authors have provided a well illustrated and well narrated video of T using interlocking clips to secure an unruptured MCA bifurcation with single clip application, endovascular treatment with incomplete aneurysm. This is a fundamental technique that must be a part of every neck coverage or observation with acceptance of natural history risk. The cerebrovascular neurosurgeon’s armamentarium. This clear and careful reader is advised to consider the points contained in this report as just demonstration should be required viewing for all neurosurgical trainees. a few of many in making complex treatment decisions. We thank the authors for their contribution. Brandon Burnsed Andrew J. Ringer Adam Arthur Memphis, Tennessee Cincinnati, Ohio OPERATIVE NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/ons/advance-article-abstract/doi/10.1093/ons/opy147/5025499 by Ed 'DeepDyve' Gillespie user on 12 July 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Operative Neurosurgery Oxford University Press

“Interlocking” Clipping of an Irregular Middle Cerebral Artery Bifurcation Aneurysm: 2-Dimensional Operative Video

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Publisher
Congress of Neurological Surgeons
Copyright
Copyright © 2018 by the Congress of Neurological Surgeons
ISSN
2332-4252
eISSN
2332-4260
D.O.I.
10.1093/ons/opy147
Publisher site
See Article on Publisher Site

Abstract

SURGICAL VIDEO “Interlocking” Clipping of an Irregular Middle Cerebral Artery Bifurcation Aneurysm: 2-Dimensional Operative Video ∗ ∗ Thomas J. Sorenson, BS , Chris Marcellino, MD , Nicola Acciarri, ‡ ∗ § ∗ § MD ,LeonardoRangelCastilla,MD , Giuseppe Lanzino, MD ∗ ‡ Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Neurologic Surgery, Institute of Neurological Sciences of Bologna, Bologna, Italy, Department of Radiology, Mayo Clinic, Rochester, Minnesota Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy147 Correspondence: Giuseppe Lanzino, MD, Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902. E-mail: Lanzino.Giuseppe@mayo.edu Middle cerebral artery (MCA) aneurysms often have an is used to obliterate 1 portion of the aneurysm and irregular morphology that might require creative clipping a fenestrated clip, with the ring of the fenestration techniques even in the case of small aneurysms. In this circling the body of the first clip, is used to obtain video, we illustrate the case of a patient with an incidental obliteration of the other lobe. This patient also had a but very irregular MCA aneurysm. The presence of contralateral internal carotid artery occlusion, and we 2 separate, asymmetric lobes was dealt with by utilizing discuss the pitfalls of temporary clipping in such a the “interlocking” clip technique in which a regular clip situation. KEY WORDS: Middle cerebral artery, Aneurysm, Clipping, Microsurgery, Interlocking, Fenestrated clip Operative Neurosurgery 0:1, 2018 DOI:10.1093/ons/opy147 Received, January 18, 2018. Accepted, May 9, 2018. Disclosure he authors provide a good video illustration of a well-established technique for stacking multiple clips on complex or wide aneurysm The authors have no personal, financial, or institutional interest in any of the necks. As such, this video is a good teaching tool, even if it does not drugs, materials, or devices described in this article. provide novel information. Other technical and medical risks, such as the impact of a calcified neck or comorbidities that could complicate surgery or shorten life-expectancy, must be considered when applying COMMENTS this technique. In so doing, the surgeon may carefully weigh these risks against other possible outcomes such as incomplete aneurysm occlusion he authors have provided a well illustrated and well narrated video of T using interlocking clips to secure an unruptured MCA bifurcation with single clip application, endovascular treatment with incomplete aneurysm. This is a fundamental technique that must be a part of every neck coverage or observation with acceptance of natural history risk. The cerebrovascular neurosurgeon’s armamentarium. This clear and careful reader is advised to consider the points contained in this report as just demonstration should be required viewing for all neurosurgical trainees. a few of many in making complex treatment decisions. We thank the authors for their contribution. Brandon Burnsed Andrew J. Ringer Adam Arthur Memphis, Tennessee Cincinnati, Ohio OPERATIVE NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/ons/advance-article-abstract/doi/10.1093/ons/opy147/5025499 by Ed 'DeepDyve' Gillespie user on 12 July 2018

Journal

Operative NeurosurgeryOxford University Press

Published: May 30, 2018

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