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Clip reconstruction and sling wrapping of a fusiform aneurysm: technical note
Louis J Kim1, Jeffrey D Klopfenstein, Robert F Spetzler
1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Objective:
To describe an alternative method of clip reconstruction and wrapping of fusiform aneurysms that provides structural support for the reconstructed parent artery or residual aneurysm.
Clinical Presentation:
A 57-year-old woman with an unruptured distal middle cerebral artery fusiform aneurysm underwent surgical treatment via a pterional craniotomy.
Technique:
A right-angled titanium clip was used to obliterate the aneurysm and to clip reconstruct the parent vessel, which was composed of a single inflow and outflow vessel. After the aneurysm was decompressed with a fine-gauge needle, the remnant/parent artery was wrapped with a thin layer of muslin gauze followed by circumferential application of the Gore-tex (W.L. Gore and Associates, Inc., Flagstaff, AZ) sling. Finally, a second right-angled aneurysm clip was applied to the free ends of the sling immediately adjacent to the parent vessel while the sling was cinched against the parent vessel. This maneuver allowed the Gore-tex material to buttress the reconstructed vessel circumferentially.
Conclusion:
Clip reconstruction with a Gore-tex sling preserves the parent vessel and simultaneously buttresses the reconstructed vessel wall with radial forces provided by the Gore-tex material. This method is a novel alternative to conventional methods for the treatment of fusiform aneurysms.
