Clip blade scissoring with titanium bayonet clip in aneurysm surgery. Two case reports

Scissoring of the cerebral aneurysm clip blades is a rare but potentially devastating complication of clipping surgery and results in aneurysm neck injury inducing rupture and/or cerebral infarction. Scissoring has been reported using titanium straight clips. Here we present two unusual cases of crossing of the blades of titanium bayonet clips by a scissors-like mechanism during surgery. The present cases suggest the following points. Bayonet clips in addition to straight clips may display the scissoring phenomenon during clipping surgery. The slipped clip should be removed immediately because the scissor-like deformed aneurysm clip may slip further and result in parent artery stenosis. Scissoring tends to happen in the presence of partial arteriosclerosis of the aneurysm neck. Before a titanium clip is used to treat an aneurysm with partially arteriosclerotic neck, reducing the amount of aneurysm filling by temporary clipping of the main vessel is useful to avoid slippage phenomena.