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The rubber dam interposition technique during intracranial aneurysm clipping under deep hypothermic circulatory
1Department of Neurological Surgery, George Washington University Medical Center, Washington, DC, USA.
Objective:
We describe a technique for isolating perforating arteries by use of a rubber sheet during the clipping of intracranial aneurysms under deep hypothermic circulatory arrest.
Methods:
After meticulous dissection of the perforating arteries from the aneurysm, a rubber sheet, cut from a surgical glove to the proper shape, is inserted between the aneurysm and the arteries to prevent arterial reattachment to the aneurysmal neck.
Results:
Even when perforators are invisible at the time of neck clipping because of a large aneurysmal body, the blade of the clip slides along the rubber sheet without injuring the vessels.
Conclusion:
With this method, an aneurysm, especially a large or giant one, can be clipped easily and safely even when the patient is in deep hypothermic circulatory arrest.