Akademik Veri Yönetim Sistemi
3rd International Rhoton Society Meeting , İstanbul, Türkiye, 22 - 26 Ağustos 2023, ss.344-345, (Tam Metin Bildiri)
Objectives: We aimed to underline the effectiveness of intraoperative clip modification (ClipMod) for anatomically challenging anterior communicating artery (ACoA) aneurysms. Background: The ACoA complex is the most common site of ruptured intracranial aneurysms which are also the most complex aneurysms of the anterior circulation. Despite the advancing technology in aneurysm clips, at times, it is still hard to securely clip the ACoA complex aneurysms given their small sizes, adherence to adjacent neurovascular structures, thin walls, challenging projection angles that make dissection harder, and atypical fenestrations (1). Even so, particular cases may require imaginative solutions such as intraoperative ClipMod for safe clipping (2). Method: We retrospectively analyzed clinical records of two patients who required ClipMod intraoperatively and presented them as video cases. Results: Case #1 underwent microsurgical clipping of a ruptured, 4-mm AcoA aneurysm. Unfortunately, given the short distance between the two A2s, it was not possible to clip the aneurysm without a compromise to the contralateral A2 with the available shortest 3-mm fenestrated clip. We then used the clip modification technique intraoperatively by shortening the clip tips with mesh-plaque cutter and smoothening the remaining sharp ends using cautery sanding. Eventually, the aneurysm was clipped successfully with the modified-fenestrated clip. Post-clipping imagings confirmed complete occlusion of the aneurysm and patency of parent arteries. Case 2# underwent microsurgical clipping for a ruptured, 1-mm AcoA aneurysm. Like Case 1#, the initial clipping attempt with the available shortest 4-mm fenestrated clip failed given the excessive length of the tips. The patient, thus, required clip modification as described above. The aneurysm was then clipped successfully using the modified-fenestrated clip, protecting bilateral A2s. Post-clipping imagings demonstrated patency of parent arteries with no residual aneurysm filling. Conclusions: ClipMod seems to be an effective option in clipping the AcoA aneurysms when available clips are too long to secure them safely. Keywords: Anterior communicating artery, Clip modification, Fenestrated aneurysm clips, Microsurgical clipping