Self-closing surgical clips for use in pericallosal artery-pericallosal artery side-to-side bypass

The authors demonstrate the feasibility of a new procedure to create intracranial interrupted microvascular anastomosis. Self-closing nitinol surgical clips were used for a pericallosal artery-pericallosal artery side-to-side bypass in a 52-year-old man harboring an unruptured large aneurysm located on the right A2 segment. The outflow artery was found to arise from the dome of the aneurysm, which was considered unsuitable for stand-alone clip ligation or coil occlusion. After bypass patency was intraoperatively confirmed using near-infrared indocyanine green videoangiography, the aneurysm and feeding artery were embolized with coils and safely occluded. Both postoperative courses were uneventful. The patient was discharged neurologically intact on the 5th postembolization day. Postprocedure angiography demonstrated no ipsilateral aneurysm filling and excellent bilateral distal outflow from the left anterior cerebral artery.